pediatric radiology (2019) 49 (suppl 1):s1 s245 · 2019-04-01 · welcome message . i am pleased to...
TRANSCRIPT
The Society for Pediatric Radiology introduced its new logo August 15, 2013. The logo communicates both the
warmth of the Society community and the strength of the members’ commitment to
excellent and thoughtful care of the pediatric patient.
The first official logo for the SPR was designed by Tamar Kahane Oestreich of
Cincinnati, Ohio in 1985. Thank you, Mrs. Oestreich.
Founded in 1959
The Society for Pediatric Radiology
62nd Annual Meeting & Postgraduate Course
April 30 – May 4, 2019
Hilton San Francisco Union Square
San Francisco, California, United States
Pediatric Imaging Technologist Program
May 2 – May 3, 2019
Jointly provided by the American College of Radiology
This supplement was not sponsored by outside commercial interests; it was funded entirely by the Society’s own resources.
Pediatric Radiology (2019) 49 (Suppl 1):S1–S245https://doi.org/10.1007/s00247-019-04376-7
TABLE OF CONTENTS
WELCOME MESSAGE ..................................................................................................................S3
SPR 2019 ORGANIZATION ..........................................................................................................S4
CONTINUING MEDICAL EDUCATION .....................................................................................S5
MAINTENANCE OF CERTIFICATION ....................................................................................S5
OBJECTIVES ...............................................................................................................................S6
DISCLOSURES ...........................................................................................................................S6
ACKNOWLEDGEMENTS .............................................................................................................S9
SPR GENERAL INFORMATION ................................................................................................S10
MISSION STATEMENT ...........................................................................................................S10
DIVERSITY & INCLUSION STATEMENT ............................................................................S10
SPR OFFICERS, DIRECTORS, COMMITTEES .........................................................................S10
SPR PAST PRESIDENTS, PREVIOUS & FUTURE MEETINGS
AWARDEES & EDWARD B.D. NEUHAUSER LECTURES .................................................... S16
SPR 2019 HONOREES ..................................................................................................................S 27
GOLD MEDALISTS .................................................................................................................. S27
PIONEER HONOREE ................................................................................................................ S31
PRESIDENTIAL RECOGNITION HONOREES ......................................................................S 32
HONORARY MEMBERS ......................................................................................................... S34
JACK O. HALLER – THOMAS L. SLOVIS AWARDEE .........................................................S 38
HEIDI PATRIQUIN AWARDEES ............................................................................................S 39
JOHN P. CAFFEY AWARDS ....................................................................................................... S40
EDWARD B.D. NEUHAUSER LECTURER ...............................................................................S47
SOCIAL EVENTS ......................................................................................................................... S48
PROGRAM SCHEDULE OF EVENTS ........................................................................................ S49
SCIENTIFIC PAPERS ................................................................................................................... S70
SCIENTIFIC PAPERS - TECHNOLOGISTS ............................................................................. S141
(T) Indicates an Imaging Technologist Program Submission
POSTERS ..................................................................................................................................... S148
CASE REPORT POSTERS ...................................................................................................... S148
EDUCATIONAL POSTERS .................................................................................................... S153
SCIENTIFIC POSTERS ...........................................................................................................S 183
POSTERS - TECHNOLOGISTS ................................................................................................. S209
CASE REPORT POSTERS - TECHNOLOGISTS ................................................................... S209
EDUCATIONAL POSTERS - TECHNOLOGISTS ................................................................ S209
SCIENTIFIC POSTERS - TECHNOLOGISTS ....................................................................... S216
AUTHOR INDEX BY ABSTRACT............................................................................................ S217
KEYWORD INDEX BY ABSTRACT ........................................................................................ S235
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S2
WELCOME MESSAGE
I am pleased to welcome you to the 62nd meeting of The Society for Pediatric Radiology in San Francisco, California.
This year’s SPR meeting planning team (THE TEAM) consists of Pinar Karakas-Rothey and Janet Reid
(Postgraduate Course Co-directors), Sarah Bixby and Paul Guillerman (Sunrise and Midday Workshop Co-directors),
myself (Scientific Program Chair), and the entire SPR administrative staff led by Angela Davis, Jennifer Boylan,
Kasey O’Dea, Jennifer Raju and Leah Gearheart. The theme of our meeting is “Learn from the Past; Innovate for
the Future”.
Following the theme and designing the program, Pinar and Janet have constructed two equally practical and creative
tracks for you to choose from in the Postgraduate Course. They are, “Tricks of the Trade: Imaging Updates with How to Do, Interpret & Report”
and “Emergency Radiology: What Not to Miss & What Surgeon Wants to Know - Case Based”. Most importantly, all of the content of the
Postgraduate Course will be recorded and made available for registrants after the course. Therefore, you should not feel that you will be missing
out on some great talks!
Similarly, Sarah and Paul have also put together nine sessions of specific topics for the Sunrise and Midday Workshops during the Scientific
Meeting. Some provocative titles of these sessions include, “What’s New that Radiation Can Do for You”, “Incidentalomas”, and “Heartless
Vascular Imaging”, to name a few. These sessions will be also be recorded so you can relax and enjoy sessions without feeling like you are missing
out on others!
For the Annual Meeting program, I want to emphasize Artificial Intelligence…or should I have used the term Machine Learning, or maybe Deep
Learning? Do we really know what AI, ML, or DL really mean? To educate all of us, our Neuhauser Lecturer, Professor Jitendra Malik of the
Department of Electrical Engineering & Computer Science (EECS) at the University of California at Berkeley, will introduce AI to us in his talk
“Deep Visual Understanding from Deep Learning”. In addition, I have tasked Shreyas Vasanawala of Lucile Packard Children’s Hospital to
organize a special session on the applications of AI in Radiology “AI: A Real Assistant for Imagers”, to immediately follow the Neuhauser
Lecture. Artificial Intelligence is here to stay and we should not be afraid of it; let’s understand it, and embrace it; let’s innovate together with the
help of AI and make an even brighter future for pediatric radiology with us directing it! I urge you to attend this year’s Neuhauser Lecture by Prof.
Malik. I trust that it will be one of many Neuhauser lectures that you will remember for a long time!
This year we will also have a new unopposed session on Thursday early afternoon: Research & Education Foundation (REF) Symposium
showcasing our grant recipients’ works followed immediately by the popular Jeopardy session with our dynamic new host, Richard Heller. The
REF Symposium will start off with a keynote talk by Miki Lustig from EECS Department of UC Berkeley. Those of you who are familiar with
magnetic resonance will have heard of Miki and his seminal work on Compressed Sensing. Miki is the only MR physicist I have been acquainted
with in the past 25 years who is wholly committed to improving pediatric MR. He will show us his vision in his talk: “Towards Pediatric Body
MR without Anesthesia”. It will be an amazing talk and he might even sing1!
There will be several keynote speakers in the various scientific oral presentation sessions by experienced clinicians and pediatric radiologists. They
all deserve special mentions. Please check the program2 for additional information. I will just point out a few world-renowned individuals such as
cardiovascular surgeon Shunji Sano, who invented the Sano Shunt procedure, speaking on stem cell research in patients with single ventricle;
pediatric urologist Larry Baskin speaking on how imaging helps in clinical urologic cases; pediatric neuroradiologist Jim Barkovich speaking
about “How Alterations of Normal Brain Development Results in Malformations" as he believes that we need to know how the brain forms before
we can understand how it ‘malforms’; vascular malformation specialist / pediatric interventional radiologist, Pat Burrows, speaking on the novel
topic of “Angioarchitecture” and she is supposedly retired! All kidding aside, we are so fortunate that Pat agreed to emerge from retirement to
deliver this talk to us. We will also get to hear the story behind the world’s first total body PET/CT scanner3 from its co-inventor, Ramsey Badawi.
I am also most excited to learn about “The Sacred Work of Caring for Children” from writer, philosopher, and pediatric radiologist, Richard
Gunderman; how advanced imaging can help in Sports Medicine by pediatric orthopedic surgeon, Nirav Pandya, and in gastrointestinal disorder
by pediatric gastroenterologist, Zachary Sellers; how fetal imaging changes fetal/perinatal surgical decisions by fetal surgeon, Darrell Cass; how
pediatric neurosurgeon, Kurtis Auguste, is utilizing Virtual Reality in his practice; learn about whether we should worry about Gadolinium
deposition in children from Alexander Radbruch, radiologist from Essen, Germany; and last but not least, how can we can standardize the imaging
and interpretation of post-natal bronchopulmonary malformation from pediatric radiologist, Bev Newman.
Finally, on Saturday May 4th, we will have six different 1/2-day courses for you to choose from including the new Cardiac CT Course
incorporating cloud-based case-studies accessible on your laptop. The Hands-on Ultrasound session will also be back by popular demand. “May
the 4th be with you!!!” “Much to learn we still have!!”
I hope you can also take advantage of the San Francisco Bay Area and come early and/or leave later to enjoy Napa Valley/Wine Country in the
north and/or Carmel/Pebble Beach/17-mile Drive in the south. Of course, there is plenty to do in the city itself with the iconic cable cars,
Fisherman’s Wharf, Pacific Coast, Alcatraz Island, etc.
The TEAM is looking forward to seeing you in San Francisco!
Taylor Chung, MD
President & Program Director
The Society for Pediatric Radiology
1. https://www.youtube.com/watch?v=hWQiwIkWRU02. https://www.pedrad.org/Portals/5/SPR%202019%20Brochure_3_15_1.pdf3. https://www.ucdavis.edu/news/human-images-worlds-first-total-body-scanner-unveiled/
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S3
SPR 2019 ORGANIZATION
2019 MEETING CURRICULUM COMMITTEE
Taylor Chung, MD (Program Director and Paper Committee Chair)
Sarah D. Bixby, MD (Poster Committee Vice Chair, Workshop Director)
Leah E. Braswell, MD (Interventional Radiology Session)
Lorna P. Browne, MD, FRCR (Cardiac Session)
Kassa Darge, MD, PhD (Hands-On Ultrasound Session)
Monica Epelman, MD (Hands-On Ultrasound Session)
J. Damien Grattan-Smith, MBBS (REF Session)
Laura A. Gruber, MBA, RT(R), RDMS, RVT (Technologist Program Director)
R. Paul Guillerman, MD (Workshop Director)
Christine Harris, RT (MR) MRSO (Technologist Program Director)
Richard E. Heller, III, MD, MBA (Jeopardy Session)
Thierry A. G. M. Huisman, MD (Neuroradiology Session)
S. Pinar Karakas, MD (Postgraduate Course Director)
Prakash M. Masand, MD (Cardiac Session)
Sarah S. Milla, MD, FAAP (Poster Committee Chair)
Helen R. Nadel, MD, FRCPC (Nuclear/Oncology Session)
Manish N. Patel, DO (Interventional Radiology Session)
Janet R. Reid, MD, FRCPC (Postgraduate Course Director and Education Session)
Cynthia K. Rigsby, MD, FACR (Cardiac Session)
Victor J. Seghers, MD, PhD (Nuclear/Oncology Session)
Dennis W. W. Shaw, MD (Neuroradiology Session)
Mahesh M. Thapa, MD (Education Session)
Shreyas S. Vasanawala, MD, PhD (AI Session)
ABSTRACT REVIEW COMMITTEE – PAPERS
Taylor Chung, MD, Chair
Christopher I. Cassady, MD, FAAP, Vice Chair
Dianna M. E. Bardo, MD
Sarah D. Bixby, MD
David A. Bloom, MD, FACR
Heather Bray, MD
Alan Brody, MD
Lorna P. Browne, MD, FRCR
Michael J. Callahan, MD
Nancy A. Chauvin, MD
Govind Chavhan, MD
Kassa Darge, MD, PhD
Jonathan R. Dillman, MD, MSc
James S. Donaldson, MD, FACR
Mark R. Ferguson, MD
Donald P. Frush, MD, FACR
Michael S. Gee, MD, PhD
J. Damien Grattan-Smith, MBBS
R. Paul Guillerman, MD
Roger K. Harned, MD, FACR
Mark J. Hogan, MD
Bamidele Kammen, MD
S. Pinar Karakas, MD
Beth M. Kline-Fath, MD
Rajesh Krishnamurthy, MD
Tal Laor, MD
John D. MacKenzie, MD
M. Beth McCarville, MD
Beverly Newman, MD, FACR
Susan Palasis, MD
John M. Racadio, MD
Janet R. Reid, MD, FRCPC
Cynthia K. Rigsby, MD, FACR
Caroline Robson, MD
Victor J. Seghers, MD, PhD
Dennis W. W. Shaw, MD
Ethan A. Smith, MD
Mahesh Thapa, MD
Andrew T. Trout, MD
Teresa Victoria, MD, PhD
Stephan D. Voss, MD, PhD
Jason P. Weinman, MD
ABSTRACT REVIEW COMMITTEE – POSTERS
Sarah S. Milla, MD, FAAP, Chair
Sarah D. Bixby, MD, Vice Chair
Anjum N. Bandarkar, MD
Madhan Bosemani, MD
Kiery A. Braithwaite, MD
Micheal A. Breen, MD
Maria A. Calvo-Garcia, MD
Gulraiz A. Chaudry, MBChB, MRCP, FRCR
Kassa Darge, MD, PhD
Nilesh Desai, MD
Paula Dickson, MD
Steven Don, MD
Eric Eutsler, MD
Judith A. Gadde, DO, MBA
Anne Gill, MD
Leslie E. Hirsig, MD
Thierry A.G.M. Huisman, MD
J. Herman Kan, MD
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S4
Neha S. Kwatra, MD
Maria F. Ladino-Torres, MD
Shailee V. Lala, MD
Jonathan M. Loewen, MD
Adeka D. McIntosh, MD
Craig S. Mitchell, DO, MA
Jonathan G. Murnick, MD
Helen R. Nadel, MD, FRCPC
Srikala Narayanan, MD
Hansel J. Otero, MD
Daniel J. Podberesky, MD
Sanjay P. Prabhu, MD
Janet R. Reid, MD, FRCPC
Susan E. Sharp, MD
Manrita K. Sidhu, MD
Bruno P. Soares, MD
Aylin Tekes-Brady, MD
Paul G. Thacker, MD, MHA
Stephanie B. Theut, MD
Alexander J. Towbin, MD
Jason Tsai, MD
Jennifer Vaughn, MD
Nghia (Jack) Vo, MD
Ewa M. Wasilewska, MD
Arash R. Zandieh, MD
IMAGING TECHNOLOGIST PROGRAM &
ABSTRACT COMMITTEE
Christine Harris, RT (MR) MRSO (Co-Chair)
Laura A. Gruber, MBA, RT(R), RDMS, RVT (Co-Chair)
Stuart Brice
Brian Fox, MBA
Charles R. Fritz, RT, MBA
Lynne Hamer, MEd., RT
Todd Lehkamp
M. Craig Morriss, MD
Stephen F. Simoneaux, MD, FACR, Advisor
R. Daniel Smock, BHS RT(R)(MR)(CT), MRSO (MRSC)
CASE OF THE DAY ORGANIZERS
Neil D. Johnson, MBBS
Christopher Sternal-Johnson
MEETING INFORMATION TECHNOLOGY
Safwan S. Halabi, MD, Meeting IT Co-Director
Alexander J. Towbin, MD, Meeting IT Co-Director
CONTINUING MEDICAL EDUCATION
ACCREDITATION STATEMENT:
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation
Council for Continuing Medical Education through the joint sponsorship of The American College of Radiology and the Society for
Pediatric Radiology. The American College of Radiology is accredited by the ACCME to provide continuing medical education for
physicians.
CREDIT DESIGNATION STATEMENT:
The American College of Radiology designates this live activity for a maximum of 37.75 AMA PRA Category 1 Credits ™. Physicians
should claim only the credit commensurate with the extent of their participation.
TECHNOLOGIST:
The American College of Radiology is approved by the American Registry of Radiologic Technologists (ARRT) as a Recognized
Continuing Education Evaluation Mechanism (RCEEM) to sponsor and/or review CME programs for Radiologic Technologists and
Radiation Therapists. The American College of Radiology designates this educational activity as meeting the criteria for up to 37.75
Category A credit hours.
MAINTENANCE OF CERTIFICATION
Qualified on January 29, 2019, select sessions from this activity meet the American Board of Radiology criteria for a self-assessment
(SAM) activity and is designated for up to 17.75 SAM credits toward the ABR Maintenance of Certification Program.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S5
LEARNING OBJECTIVES
The 2019 62nd Annual Meeting & Postgraduate Course will provide pediatric and general radiologists with an opportunity to do the
following:
1. Summarize the most current information on state-of-the-art pediatric imaging and the practice of pediatric radiology.
2. Describe and apply new technologies and imaging findings for pediatric imaging.
3. Discuss trends in research and education concerning the care and imaging of pediatric patients.
4. Identify common challenges facing pediatric radiologists, and possible solutions.
5. Describe and apply basic principles for implementing quality and safety programs in pediatric radiology.
6. Evaluate and apply means of managing radiation exposure and the need for sedation/anesthesia during diagnostic imaging
and image-guided therapy.
At the conclusion of the experience, participants should have an improved understanding of the technologies discussed, increased
awareness of the benefits and costs of diagnostic imaging in children and of ways to minimize risks, and an improved general knowledge
of pediatric radiology.
DISCLOSURE STATEMENT
In compliance with ACCME requirements and guidelines, the ACR has developed a policy for review and disclosure of potential conflicts
of interest, and a method of resolution if a conflict does exist. The ACR maintains a tradition of scientific integrity and objectivity in its
educational activities. In order to preserve this integrity and objectivity, all individuals participating as planners, presenters, moderators
and evaluators in an ACR educational activity or an activity jointly sponsored by the ACR must appropriately disclose any financial
relationship with a commercial organization that may have an interest in the content of the educational activity.
The following planners, presenters, staff and evaluators have disclosed that neither they nor their spouse/partner has any financial interests,
arrangements or affiliation in the context of this activity:
PROGRAM PLANNERS/FACULTY
Adina L. Alazraki, MD
Ahmad I. Alomari, MD
Alan Daneman, MD
Alan E. Schlesinger, MD
Alexander Radbruch, MD
Allison S. Aguado, MD
Ami Gokli, MD
Amie S. Robinson, BSRT, (R)(MR) CCRP
Amy R. Mehollin‐Ray, MD
Andrea Rossi, MD
Andrew S. Phelps, MD
Andrew Schapiro, MD
Andy Tsai, MD, PhD
Angela Quintello
Anjum N. Bandarkar, MD
Anne Gill, MD
Aparna Joshi, MD
Apeksha Chaturvedi, MBBS, MD
Arun Rangaswami, MD
Ashok Panigrahy, MD
Asim F. Choudhri, MD
Aylin Tekes, MD
Bamidele F. Kammen, MD
Benjamin Thompson, DO
Beverley Newman, MD, FACR
Boaz Karmazyn, MD
Brandi Kozak, RDMS
Brandon P. Brown, MD, MA, FAAP
Brandy Bales, RPA, RT(R)(M)
Brian D. Coley, MD, FACR, FAIUM
Brooke S. Lampl, DO
Bruce R. Parker, MD, FACR
Bruno P. Soares, MD
Camilo Jaimes, MD
Carlos F. Ugas Charcape, MD
Carol E. Barnewolt, MD
Charles Stanley
Christine Harris, RT (MR) MRSO
Christina Sammet, PhD
Christopher I. Cassady, MD, FAAP
Christopher Lam, MD
Christopher Newton, MD
Cicero T. Silva, MD
Cory M. Pfeifer, MD, MS, FAAP
Cynthia K. Rigsby, MD, FACR
D. Gregory Bates, MD
J. Damien Grattan‐Smith, MBBS
Darrell L. Cass, MD
David B. Larson, MD
David Saul, MD
Delma Y. Jarrett, MD
Dennis W. W. Shaw, MD
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S6
Diego Jaramillo, MD, MPH
Donald P. Frush, MD, FACR
Dorothy I. Bulas, MD, FACR
Douglas C. Rivard, DO
Edward R. Oliver, MD, PhD
Elad Nevo, M.S., RT(MR)(N)(CT), CNMT
Elizabeth Silvestro, MSc
Ellen M. Chung, MD
Ellen S. Park, MD, MS
Emily S. Orscheln, MD
Eric Hoggard, MD
Erica Gates
Erica L. Riedesel, MD
Evan J. Zucker, MD
Francisco Perez, MD, PhD
Gabe Linke, BSRT (R)(MR)
Gary L. Hedlund, DO
Gary R. Schooler, MD
Geetika Khanna, MD, MS
George A. Taylor, MD, FACR
George S. Bisset, MD, FACR
Georgina Prevett, MS, RT(R)(N) (CT)(MR), CNMT
Giridhar Shivaram, MD
Giulio Zuccoli, MD
HaiThuy N. Nguyen, MD
Harriet J. Paltiel, MD
Heather Bray, MD
Heike E. Daldrup‐Link, MD, PhD
Helen R. Nadel, MD, FRCPC
Hisham Dahmoush, MBBCh
Houchun Harry Hu, PhD
Hyun Woo Goo, MD, PhD
Jaishree Naidoo, FCRad
James E. Crowe, MD
Jane C. Cook, DO
Janet Mar, RDMS
Janet R. Reid, MD, FRCPC
Jason N. Wright, MD
Jeanne "Mei‐Mei" S. Chow, MD
Jeannie K. Kwon, MD
Jennifer E. Lim‐Dunham, MD, FACR
Jennifer Nicholas, MD
Jerry R. Dwek, MD
Jie C. Nguyen, MD, MS
Jitendre Malik, PhD
John D. Mackenzie, MD
Jonathan G. Murnick, MD, PhD
Joseph Cheng, MD
Joseph MacLean, CNMT
Joshua Nickerson, MD
Judith A. Gadde, DO, MBA
Kara Groom, RDMS
Kara Meister
Karen Lyons, MB, BCh, BAO
Karun Sharma, MD
Kassa Darge, MD, PhD
Katie Busher
Keith J. Strauss, MSc, FACR
Kevin Shoaf, ARRT RT
Kieran J. Frawley, MBBS
Kirsten Ecklund, MD
Korgun Koral, MD
Kristen Yeom, MD
Kurtis Auguste, MD
Lacey Gander, RDMS
Ladonna J. Malone, MD
Lamont Hill, RT, ARDMS
Laura Gruber, MBA, RT(R), RDMS, RVT
Laura L. Hayes, MD
Laura Poznick, RDMS
Laura Z. Fenton, MD, FACR
Lauren W. Averill, MD
Leah E. Braswell, MD
Lindsay Griffen, MD
Lisa J. States, MD
Lorna P. Browne, MD, FRCR
Luis F. Goncalves, MD
Lydia Bajno, MD
Lynn A. Fordham, MD, FACR
M. Beth McCarville, MD
M. Ines Boechat, MD, FACR
Maggie Zhong, MD
Mahesh M. Thapa, MD
Manish Patel, DO
Manohar Shroff, MD, FRCPC
Maria G. Smith, BS, RDMS, RVT
Mariana L. Meyers, MD
Marielle Fortier, MD
Mark Goce, RDMS
Mark R. Ferguson, MD
Marta Hernanz‐Schulman, MD, FACR
Martha M. Munden, MD
Maryam Ghadimi Mahani, MD
Matthew A. Zapala, MD, PhD
Matthew R. Hammer, MD
Matthias Wagner, MD
Merima Karastanovic, MS, RT(R)(MR)
Merlye Eklund, MD
Michael J. Callahan, MD
Michael M. Moore, MD
Michael R. Acord, MD
Michael S. Gee, MD, PhD
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S7
Micheal A. Breen, MBBCh BAO
Misun Hwang, MD
Molly E. Dempsey, MD
Monica Atalabi, MD
Monica Epelman, MD
Nadia F. Mahmood, MD
Nalin Gupta, MD
Neha S. Kwatra, MD
Nghia (Jack) Vo, MD
Nicholas Rubert, PhD
Nicholas V. Stence, MD
Nikki Butler, BMSc, RT(R)(QM)
Olivier Gavaert, PhD
Oscar M. Navarro, MD
Pamela M. Ketwaroo, MD
Parker Stanley
Patricia E. Burrows, MD
Patricia T. Acharya, MD
Patrick Waren, MD
Paul G. Thacker, MD, MHA
Pek‐Lan Khong, MBBS, FRCR
R. Paul Guillerman, MD
Rajesh Krishnamurthy, MD
Rama S. Ayyala, MD
Raymond W. Sze, MD
Ricardi Faingold, MD
Richard B. Gunderman, MD, PhD, FACR
Richard E. Heller III, MD, MBA
Richard Southard, MD
Robert C. Orth, MD, PhD
Ronald A. Cohen, MD
Roxanne Munyon
S. Pinar Karakas, MD
Safwan Halabi, MD
Sarah D. Bixby, MD
Sarah Desoky, MD
Sarah J. Menashe, MD
Sarah S. Milla, MD, FAAP
Scott R. Dorfman, MD
Sherwin S. Chan, MD
Shireen Hayatghaibi, MA, MPH
Shreyas Vasanwala, MD, PhD
Shunji Sano, MD, PhD
Sjirk J. Westra, MD, FACR
Skorn Ponrartana, MD
Spencer Behr, MD, PhD
Stephan D. Voss, MD, PhD
Stephanie Suller, RDMS
Steven Don, MD
Sudha A. Anupindi, MD
Sumit Pruthi, MBBS, DNB
Summer L. Kaplan, MD, MS
Susan E. Sharp, MD
Susan Palasis, MD
Talissa Altes, MD
Tara Cielma
Teresa Victoria, MD, PhD
Theirry A. G. M. Huisman, MD
Timothy N. Booth, MD
Timothy R. Singewald, MD
Todd Abruzzo, MD
Trista Raymer Maule, RT, (R)(CT)(MR)
Trudy Morgan, RDMS
Unni K. Udayasankar, MD
Victor J. Seghers, MD, PhD
The planners and faculty listed below have disclosed the following relevant financial relationships. Potential conflicts have been resolved.
PROGRAM PLANNERS/FACULTY WITH DISCLOSURES
A. James Barkovich, MD NIH – Research Grant
A. Carl Merrow, MD Elsevier - Consultant, Honoraria, Royalties
Akshay Chaudhari, PhD
Brain Key - Advisory Board, Subtle Medical - Deep Learning Research Scientist,
LVIS Corporation - Equity, Subtle Medical - Deep Learning Research Scientist,
Skope MR Technologies - ex Technology and Application Specialist
Alan S. Brody, MD Vertex Pharmaceuticals, Consultant
Alexander J. Towbin, MD IBM Watson Health; Applied Radiology - Consultant, Honoraria, Siemens; Guerbet;
Cystic Fibrosis Foundation - Research Grants
Andrew T. Trout, MD Guerbet - Consultant, Honoraria, iiCME - Speakers Bureau, Elsevier, Wolters
Kluwer - Royalties, JRCNMT - Officer, Siemens, Canon - Research Grants
Arthur B. Meyers, MD Amirsys, Elsevier – Royalties
Birgit B. Ertl‐Wagner, MD, MHBA Siemens - Spouse Stock, Springer - Royalty
Dianna M.E. Bardo, MD Koninklijke Philips, NV - Consultant, Honoraria, Speakers Bureau
David M. Biko, MD Wolters Kluwer - Royalty
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S8
Erika Rubesova, MD Clementia Pharmaceuticals - Consultant
Ethan A. Smith, MD Elsevier – Royalties
Govind B. Chavhan, MD Bayer Inc. - Consultant, Honoraria
Henry J. Baskin, MD UpToDate - Consultant
Jesse Courtier, MD HoloSurg3D, Inc – Equity
Jonathan R. Dillman, MD, MSc Canon Medical Systems, Siemens Medical Solutions USA, Bracco Diagnostics -
Research Grants
Juan Santos, PhD HeartVista, Inc. - Equity, Officer
Judy H. Squires, MD Elsevier - Royalty
Laurence C. Baskin, MD UpToDate - Consultant, NIH - Research Grants
Mai‐Lan Ho, MD RSNA Scholar Grant, SPR Pilot Award, ASHNR Hanafee Grant - Research Grants
Matthew P. Lungren, MD Nines Inc - Consultant, Honoraria
Michael Aquino, MD Elsevier - Royalty
Michael "Miki" Lustig, PhD InkSpace Imaging - Equity Interest/Stock Options, GE Healthcare - Research Grants
Nirav Pandya, MD Orthopediatrics - Consultant, Honoraria
Prakash M. Masand, MD Canon Medical Systems, Phillips Medical Systems - Consultant; Canon Medical
Systems, Speakers Bureau; Amirsys - Royalty
Ramsey D. Badawi, MD, PhD United Imaging Healthcare - Research Grant
Ramesh Iyer, MD Wolters Kluwer - Royalty
Ricardo Restrepo, MD Elsevier - Royalty
Sandy Napel, PhD Fovia Inc., Carestream Inc, and Radlogics Inc. - Consultant, Honoraria
Susan J. Back, MD Siemens - Research Grant, Philips - Research Grant, Bracco - Education Grant
Steven J. Kraus, MD, MS Elsevier - Royalty
Teresa Chapman, MD, MA Wolters Kluwer - Royalty
Zachary M. Sellers, MD Cystic Fibrosis Foundation, NIH - Research Grants
ACKNOWLEDGEMENTS– As of March 14, 2019
The Society for Pediatric Radiology gratefully acknowledges the support of the of the following companies in presenting the 62nd Annual
Meeting & Postgraduate Course.
PLATINUM LEVEL SUPPORTER
Canon Medical Systems USA, Inc.
GE Healthcare
Philips Healthcare
Siemens Healthineers
SILVER LEVEL SUPPORTER
United Imaging Healthcare
BRONZE LEVEL SUPPORTER
Bayer HealthCare LLC
EXHIBITORS
Advocate Children's Hospital
Agfa Radiology Solutions
Arterys
Bracco Diagnostics Inc
Children's Hospital of Philadelphia
ChiRhoClin
Circle Cardiovascular Imaging
Elsevier, Inc.
FUJIFILM Medical Systems USA, Inc.
Guerbet LLC
Illuminate
KindVR
KinetiCor, Inc
LocumTenens.com
MEDNAX Radiology Solutions
Mindray North America
Samsung
ScImage
SealCath, LLC
SpellBound
St. Jude Children's Research Hospital
SuperSonic Imagine
Wolters Kluwer
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S9
SPR GENERAL INFORMATION
MISSION STATEMENT
The Society for Pediatric Radiology is dedicated to fostering excellence in pediatric health care through imaging and image-guided care.
DIVERSITY & INCLUSION STATEMENT
The Society for Pediatric Radiology actively promotes diversity and inclusion at all levels of training, practice and leadership for the
benefit of our patients, our profession and for the Society as a whole.
SPR OFFICERS, DIRECTORS AND COMMITTEES 2018–2019
BOARD OF DIRECTORS
Peter J. Strouse, MD, FACR, Chair, Board of Directors and
Editor
Taylor Chung, MD, President
Christopher I. Cassady, MD, FAAP, President-Elect
J. Damien Grattan-Smith, MBBS, 1st Vice President and
President, SPR Research and Education Foundation
Cynthia K. Rigsby, MD, FACR, 2nd Vice President
Michael J. Callahan, MD, Secretary
Laura Z. Fenton, MD, FACR, Secretary-Elect and Director
Stephen F. Simoneaux, MD, FACR, Treasurer
Jonathan R. Dillman, MD, MSc, Director
Josée Dubois, MD, Director
Beth M. Kline-Fath, MD, Director
Susan Palasis, MD, Director
Teresa Victoria, MD, PhD, Director
James. S. Donaldson, MD, FACR, Past President
Diego Jaramillo, MD, MPH, Past President
Brian D. Coley, MD, FACR, FAIUM, Past President
Richard A. Barth, MD, FACR, FAAP, ACR Commission on
Pediatric Radiology Liaison
Donald P. Frush, MD, FACR, Image Gently Liaison
Benjamin H. Taragin, MD, Web Editor
Sarah S. Milla, MD, FAAP, AAP Liaison
Molly E. Dempsey, MD, SCORCH President
M. Ines Boechat, MD, FACR, WFPI Liaison
ABDOMINAL IMAGING COMMITTEE
Jonathan R. Dillman, MD, MSc, Chair
Sudha A. Anupindi, MD, Vice Chair
Govind B. Chavhan, MD
Ellen M. Chung, MD
Meryle Eklund, MD
Hansel J. Otero, MD
Daniel J. Podberesky, MD
Brian S. Pugmire, MD
Anil G. Rao, DMRD, DNB
Gary R. Schooler, MD
Ethan A. Smith, MD
Andrew T. Trout, MD
BYLAWS COMMITTEE
Peter J. Strouse, MD, FACR, Chair
Taylor Chung, MD
Michael J. Callahan, MD
Laura Z. Fenton, MD, FACR
Susan Palasis, MD
CARDIAC IMAGING COMMITTEE
Lorna P. Browne, MD, FRCR, Chair
Maryam Ghadimi Mahani, MD, Vice Chair
David M. Biko, MD
Joo Y. Cho, MD
Joseph Davis, MD
Mark R. Ferguson, MD
Jamie Frost, DO
Preetam Gongidi, MD
Brian Handly, MD
Eric Hoggard, MD
Siddharth P. Jadhav, MD
Christopher Keup, MD
Ramkumar Krishnamurthy, PhD
Christopher Lam, MD
Karen Lyons, MB, BCh, BAO
Ladonna J. Malone, MD
Prakash M. Masand, MD
Erin Opfer, MD
Cynthia K. Rigsby, MD, FACR, Advisory
Mike Seed, MBBS
Laureen M. Sena, MD, Advisory
Ting Y. Tao, MD, PhD
Smyrna Tuburan, MD
CHILD ABUSE COMMITTEE
Sabah Servaes, MD, Chair
Arabinda K. Choudhary, MBBS, MRCP, FRCR, Vice Chair
David A. Bloom, MD
Karen Blumberg, MD, FACR
Tejaswini K. Deshmukh, MD
Michael F. Fadell, II, MD
Laura L. Hayes, MD
Gary L. Hedlund, DO
Muhammad N. Khan, MD
Jeannie K. Kwon, MD
Shailee V. Lala, MD
Megan B. Marine, MD
Bradley A. Maxfield, MD
Kenneth L. Mendelson, MD
David M. Mirsky, MD
Joelle Moreno, JD
Michael A. Murati, MD
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S10
Sandeep Narang, MD
Susan Palasis, MD
Ashishkumar K. Parikh, MD
Jeannette M. Perez-Rossello, MD, FACR
Cory Pfeifer, MD, FAAP
Veronica J. Rooks, MD
Daniel M. Schwartz, MD
Dana S. Schwartz, MD
V. Michelle Silvera, MD
Heba S. Takrouri, MBBS
Chido Vera, MD
Gregory A. Vorona, MD
Matthew A. Zapala, MD, PhD
Stephen D. Brown, MD, Advisory
Richard I. Markowitz, MD, FACR, Advisory
Peter J. Strouse, MD, FACR, Advisory
CONTRAST-ENHANCED ULTRASOUND COMMITTEE
M. Beth McCarville, MD, Chair
Susan J. Back, MD, Vice Chair
Patricia T. Acharya, MD
Carol E. Barnewolt, MD
Joo Y. Cho, MD
Kassa Darge, MD, PhD, Advisory
Reza Daugherty, MD
Lynn A. Fordham, MD, FACR
Ami Gokli, MD
Preetam Gongidi, DO
Misun Hwang, MD
Jeannie K. Kwon, MD
Annie Lim, DO
Martha M. Munden, MD
Harriet J. Paltiel, MD
Judy H. Squires, MD
Abhay S. Srinivasan, MD
CT COMMITTEE
John D. MacKenzie, MD, Chair
Prakash M. Masand, MD, Vice Chair
Sheila C. Berlin, MD, Advisory
Tushar Chandra, MBBS, MD
Apeksha Chaturvedi, MD
Joo Y. Cho, MD
Kara G. Gill, MD
Aparna Joshi, MD
Grace S. Phillips, MD
Karuna V. Shekdar, MD
Richard Southard, MD
Jason P. Weinman, MD
Sjirk J. Westra, MD
DIVERSITY AND INCLUSION COMMITTEE
Ashok Panigrahy, MD, Co-Chair
Stephanie E. Spottswood, MD, MSPH, Co-Chair
Adebunmi Adeyiga, MD
Aparna Annam, DO
Christopher I. Cassady, MD, FAAP, President-Elect
Taylor Chung, MD, President
Gregory L. Compton, MBBS
Sarah Desoky, MD
Marta Hernanz-Schulman, MD, FACR
Katrina Hughes, MD
Melanie B. Levin, MD
Maria-Gisela Mercado-Deane, MD
Cindy R. Miller, MD
Kristi Bogan Oatis, MD
Tina Young Poussaint, MD, FACR
Sheena Saleem, MD
Amit S. Sura, MD, MBA
Philip Teitelbaum, MD
Adrienne F. Thompson, MD
Chido Vera, MD
Valerie L. Ward, MD, MPH
Lisa Wheelock, MD
Ammie M. White, MD
Sonia Wright, MD
EDUCATION-CURRICULUM COMMITTEE
Christopher I. Cassady, MD, FAAP, Chair
Sarah S. Milla, MD, FAAP, Vice Chair
Michael J. Callahan, MD
Monica Epelman, MD
Laura Z. Fenton, MD
Liliane H. Gibbs, MD
J. Damien Grattan-Smith, MBBS
Safwan S. Halabi, MD
Daniel J. Podberesky, MD
Sanjay P. Prabhu, MBBS FRCR
Janet R. Reid, MD, FRCPC
Michele Retrouvey, MD
Cynthia K. Rigsby, MD, FACR
Peter J. Strouse, MD, FACR
Benjamin H. Taragin, MD
Mahesh M. Thapa, MD
Smyrna Tuburan, MD
Laura J. Varich, MD
Kevin Wong, DO
EMERGENCY RADIOLOGY & TRAUMA COMMITTEE
Susan D. John, MD, FACR, Chair
Michael R Aquino, MD, Vice Chair
Sandra M. Allbery, MD
Joseph T. Davis, MD
Tejaswini K. Deshmukh, MD
David Dinan, MD
Michael P. George, MD
Ashwin Hegde, MD, FRCPC
Jeanne G. Hill, MD
Victor M. Ho-Fung, MD
Tara L. Holm, MD
James D. Ingram, MD, FACR
Paul J. Iskander, MD
Jennifer H. Johnston, MD
Summer L. Kaplan, MD, MS
George C. Koberlein, MD
Jonathan M. Loewen, MD
Michael A. Murati, MD
Michael P. Nasser, MD
Jennifer Veltkamp, MD
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S11
FELLOWSHIP PROGRAM DIRECTOR COMMITTEE
Paula N. Dickson, MD, Co-Chair
Sabah Servaes, MD, Co-Chair
FETAL IMAGING COMMITTEE
Teresa Victoria, MD, PhD, Chair
Mariana L. Meyers, MD, Vice Chair
Rama S. Ayyala, MD
Richard A. Barth, MD, FACR, FAAP
Micheal A. Breen, MBBCh
Brandon P. Brown, MD, FAAP
Dorothy I. Bulas, MD, FACR, FAAP
Christopher I. Cassady, MD, FAAP
Gabrielle C. Colleran, MD
Patricia Cornejo, MD
Nilesh Desai, MD
Ryne A. Didier, MD
Michael S. Gee, MD, PhD
Luis Goncalves, MD
Carolina V. Guimaraes, MD
Camilo Jaimes Cobos, MD
Pamela M. Ketwaroo, MD
Paggie Kim, MD
Beth M. Kline-Fath, MD
Amy B. Kolbe, MD
Jennifer Kucera, MD
Leann E. Linam, MD
David M. Mirsky, MD
Usha D. Nagaraj, MD
Edward R. Oliver, MD
Erika Rubesova, MD
FINANCE COMMITTEE
Avrum N. Pollock, MD, FRCPC, Chair
Narendra S. Shet, MD
Amit S. Sura, MD, MBA
Neil Vachhani, MD
Shannon G. Farmakis, MD
Stephen F. Simoneaux, MD, FACR
Christopher I. Cassady, MD, FAAP
J. Damien Grattan-Smith, MBBS
Cynthia K. Rigsby, MD, FACR
HISTORY COMMITTEE
Alan E. Schlesinger, MD, Historian
HONORS COMMITTEE
Brian D. Coley, MD, FACR, FAIUM, Chair
James S. Donaldson, MD, FACR
Diego Jaramillo, MD, MPH
INFORMATICS COMMITTEE
Safwan S. Halabi, MD, Chair
Jeannie K. Kwon, MD, Vice Chair
Steven L. Blumer, MD
Brian D. Handly, MD
Mai-Lan Ho, MD
Neil U. Lall, MD
Annie Lim, DO
Morgan McBee, MD
Saad A. Ranginwala, MD
Marla BK Sammer, MD
Uygar Teomete, MD
Alexander J. Towbin, MD, Advisory
Esben S. Vogelius, MD
Evan J. Zucker, MD
INTERVENTIONAL COMMITTEE
Manish N. Patel, DO, Chair
Leah E. Braswell, MD, Vice Chair
Raja Shaikh, MD
Joseph T. Davis, MD
Matthew P. Lungren, MD
Anne Gill, MD
Radu Nicolaescu, MD
Abhay S. Srinivasan, MD
Timothy R. Singewald, MD
Ranjith Vellody, MD
Fabiola C. Weber, MD
MR COMMITTEE
Michael S. Gee, MD, PhD, Chair
Govind B. Chavhan, MD, Vice Chair
Sudha A. Anupindi, MD
Sherwin S. Chan, MD
Tushar Chandra, MBBS, MD
Apeksha Chaturvedi, MD
Taylor Chung, MD, Advisory
Jesse Courtier, MD
Jorge H. Davila-Acosta, MD
Shahnaz Ghahremani Koureh, MD
Mai-Lan Ho, MD
Camilo Jaimes Cobos, MD
Hee-Kyung Kim, MD
Amy B. Kolbe, MD
Archana Malik, MD
Michael M. Moore, MD
Hansel J. Otero, MD
Skorn Ponrartana, MD
Anil G. Rao, DMRD, DNB
Gary R. Schooler, MD
Mitchell L. Simon, MD
Susan Sotardi, MD
Gayathri Sreedher, MD
Unni K. Udayasankar, MD
Shreyas S. Vasanawala, MD, PhD, Advisory
Teresa Victoria, MD, PhD
Esben Vogelius, MD
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S12
MUSCULOSKELETAL IMAGING COMMITTEE
Jerry R. Dwek, MD, Chair
Arthur B. Meyers, MD, Vice Chair
Sebastien Benali, MD
Sarah D. Bixby, MD
Tushar Chandra, MBBS, MD
Nancy A. Chauvin, MD
Andrew J. Degnan, MD
Kirsten Ecklund, MD
Eric Eutsler, MD
R. Paul Guillerman, MD
Matthew R. Hammer, MD
Siddharth P. Jadhav, MD
Shawn E. Kamps, MD
Hee-Kyung Kim, MD
Archana Malik, MD
Tracey R. Mehlman, MD
Jie C. Nguyen, MD, MS
Allison K. Person, MD
Jonathan Samet, MD
Amisha J. Shah, MD
Mahesh M. Thapa, MD
Andy Tsai, MD
Jennifer Veltkamp, MD
NEONATAL IMAGING COMMITTEE
Rama S. Ayyala, MD, Chair
Emily M. Janitz, DO, Vice Chair
Krista L. Birkemeier, MD
Judy A. Estroff, MD
Kara G. Gill, MD
Mai-Lan Ho, MD
Tara L. Holm, MD
Misun Hwang, MD
Shailee V. Lala, MD
Brooke S. Lampl, DO
David W. McDonald, MD
Richard Parad, MD
Pallavi Sagar, MD
Cassandra M. Sams, MD
Mitchell L. Simon, MD
Jennifer L. Williams, MD
NEURORADIOLOGY COMMITTEE
Dennis W. W. Shaw, MD, Chair
Thierry A. G. M. Huisman, MD, Vice Chair
Mariaem M. Andres, MD
Ravi Bhargava, MD
Timothy N. Booth, MD
Shankar Srinivas Ganapathy, MD
Carolina V. Guimaraes, MD
Mai-Lan Ho, MD
Susan Palasis, MD
Sumit Pruthi, MD
Gaurav Saigal, MD
Rupa Radhakrishnan, MBBS
Raghu H. Ramakrishnaiah, MD
Caroline D. Robson, MBChB
Nancy K. Rollins, MD
Matthew T. Whitehead, MD
Jason N. Wright, MD
Charles R. Fitz, MD, Advisory
NOMINATING COMMITTEE
Peter J. Strouse, MD, FACR, Chair
Judy A. Estroff, MD
Richard E. Heller, III, MD, MBA
Tara L. Holm, MD
Sabah Servaes, MD
Raymond W. Sze, MD
Stephan D. Voss, MD, PhD
NUCLEAR MEDICINE COMMITTEE
Helen R. Nadel, MD, FRCPC, Chair
Victor J. Seghers, MD, PhD, Vice Chair
Adina L. Alazraki, MD, FAAP
Deepa R. Biyyam, MB BS
Sachin Kumbhar, MD
Neha S. Kwatra, MD
Hollie A. Lai, MD
Maria R. Ponisio, MD
Sabah Servaes, MD
Summit H. Shah, MD, MPH
Barry L. Shulkin, MD, MBA
Lisa J. States, MD
S. Ted Treves, MD
Stephan D. Voss, MD, PhD
Jennifer L. Williams, MD
ONCOLOGY COMMITTEE
Adina L. Alazraki, MD, FAAP, Chair
Susan E. Sharp, MD, Vice Chair
Govind B. Chavhan, MD
Kelly R. Dietz, MD
Meryle Eklund, MD
Anne Gill, MD
Sue C. Kaste, DO
Muhammad N. Khan, MD
Geetika Khanna, MD, MS
Arzu Kovanlikaya, MD
Irit R. Maianski, MD
M. Beth McCarville, MD
Erika Pace, MD
Marguerite T. Parisi, MD, MS
Edward J. Richer, MD
Judy H. Squires, MD
Lisa J. States, MD
Stephan D. Voss, MD, PhD
Sireesha Yedururi, MD
PHYSICIAN RESOURCES COMMITTEE
Rebecca L. Hulett-Bowling, MD, Chair
Kristen B. Thomas, MD, Vice Chair
Ellen M. Chung, MD
Shannon G. Farmakis, MD
Brooke S. Lampl, DO
Janice D. McDaniel, MD
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S13
Debbie J. Merinbaum, MD
Melinda Jane Morris, MD
Unni K. Udayasankar, MD
POST-MORTEM IMAGING COMMITTEE
Mary P. Harty MD, Chair
Pierre J. Schmit, MD, Vice Chair
Mutaz Alassar, MD
Lucia Carpineta, MD
William R. Carter, MD
Kristin Fickenscher, MD
Sharon W. Gould, MD
Timothy Higgins, MD
Jeanne G. Hill, MD
Tatum S. Johnson, MD
Vinay V.R. Kandula, FRCR, MRCP
Muhammad N. Khan, MD
Amy R. Mehollin-Ray, MD
Elka Miller, MD
Melinda J. Morris, MD
Nina Stein, MD
PROFESSIONALISM COMMITTEE
Brandon P. Brown, MD, FAAP, Chair
R. Paul Guillerman, MD, Vice Chair
Patricia Acharya, MD
Rama Ayyala, MD
Micheal A. Breen, MBBCh
Stephen D. Brown, MD
Dorothy I. Bulas, MD, FACR, FAAP
Teresa Chapman, MD, MA
Jeanne G. Hill, MD
Anastasia Hryhorczuk, MD
Susan D. John, MD, FACR
Craig M. Johnson, DO
Pamela M. Ketwaroo, MD
Sarah S. Milla, MD, FAAP
Tina Young Poussaint, MD, FACR
Sabah Servaes, MD
Raymond W. Sze, MD
PUBLICATIONS COMMITTEE
Ethan A. Smith, MD, Chair
Andrew T. Trout, MD, Vice Chair
Michael J. Callahan, MD, Ex Officio
Johan G. Blickman, MD, PhD
Sarah J. Menashe, MD
Ashok Panigrahy, MD
Sumit Pruthi, MD
Pooja D. Thakrar, MD
Peter J. Strouse, MD, FACR, Editor
Brian D. Coley, MD, FACR, FAIUM, Assistant Editor
Geetika Khanna, MD, MS, Assistant Editor
Cynthia K. Rigsby, MD, FACR, Assistant Editor
PUBLIC POLICY COMMITTEE
David W. Swenson, MD, Chair
Aparna Annam, DO, Vice Chair
Patricia T. Acharya, MD
Neil Anand, MD
Richard A. Barth, MD, FACR, FAAP
Richard M. Benator, MD, FACR, Advisory
Andrew J. Degnan, MD
Michael L. Francavilla, MD
Marta Hernanz-Schulman, MD, FACR, Advisory
Susan D. John, MD, FACR
Michael E. Katz, MD, FACR
Asef B. Khwaja, MD
Beth M. Kline-Fath, MD
Annie Lim, DO
Lauren Y. Peng, MD
Anil G. Rao, DMRD, DNB
Erica L. Riedesel, MD
Summit H. Shah, MD
Susan Sotardi, MD
Jonathan Swanson, MD
QUALITY AND SAFETY COMMITTEE
Ramesh S. Iyer, MD
Raymond W. Sze, MD, Vice Chair
Neil Anand, MD
Einat Blumfield, MD
Tushar Chandra, MBBS, MD
Govind B. Chavhan, MD
Thomas R. Goodman, MBBCh
Muhammad N. Khan, MD
Michael M. Moore, MD
Christina L. Sammet, PhD
Arta-Luana Stanescu, MD
David W. Swenson, MD
Chido Vera, MD
Amy C. Danehy, MD
Aparna Joshi, MD
Ammie M. White, MD
SPR REPRESENTATIVES
Richard A. Barth, MD, FACR, ARR and ACR Commission on
Pediatric Radiology
Stephen F. Simoneaux, MD, FACR, ABR
Beverley Newman, MD, FACR, ACR
Sarah Milla, MD, FAAP, AAP
THORACIC IMAGING COMMITTEE
Paul G. Thacker, MD, MHA, Chair
Sarah Desoky, MD, Vice Chair
David M. Biko, MD
Alan S. Brody, MD
Matthew Cooper, MD
Monica Epelman, MD
Robert Fleck, MD
Maryam Ghadimi Mahani, MD
Paul J. Iskander, MD
Manisha Jana, MBBS, MD, FRCR
Arzu Kovanlikaya, MD
David Manson, MD
Beverley Newman, MD, FACR
Pallavi Sagar, MD
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S14
Jason P. Weinman, MD
Evan J. Zucker, MD
ULTRASOUND COMMITTEE
Monica Epelman, MD, Chair
Andrew S. Phelps, MD, Vice Chair
Angela J. Beavers, MD
Richard D. Bellah, MD, Advisory
Christian L. Carlson, MD
Tushar Chandra, MBBS, MD
Paul Clark, DO
Harris L. Cohen, MD, FACR
Ricardo Faingold, MD
Rachelle Goldfisher, MD
Kerri Highmore, MD
Vinay VR Kandula, FRCR, MRCP
Arzu Kovanlikaya, MD
Sosamma T. Methratta, MD
HaiThuy N. Nguyen, MD
Rodrigo V. Ozelame, MD
Harriet J. Paltiel, MD
Michele Retrouvey, MD
Erica L. Riedesel, MD
Henrietta Kotlus Rosenberg, MD, FACR
Cicero T. Silva, MD
Judy H. Squires, MD
Neil Vachhani, MD
Dayna M. Weinert, MD
Jonathan R. Wood, MD
WEBSITE EDITORIAL COMMITTEE
Benjamin H. Taragin, MD, Chair and Web Editor
Kiery A. Braithwaite, MD
Matthew R. Hammer, MD
Peter A. Marcovici, MD, Assistant Web Editor
Amy R. Mehollin-Ray, MD, Assistant Web Editor
Anh-Vu H. Ngo, MD, Assistant Web Editor – Social Media
Mahesh M. Thapa, MD, Assistant Web Editor – Education
Lincoln M. Wong, MD
SPR RESEARCH AND EDUCATION FOUNDATION
J. Damien Grattan-Smith, MBBS, President
Taylor Chung, MD, Vice President
Michael J. Callahan, MD, Secretary
Laura Z. Fenton, MD, FACR, Secretary-Elect
Stephen F. Simoneaux, MD, FACR, Treasurer
Sudha Anupindi, MD
R. Paul Guillerman, MD
Joseph J. Junewick, MD
William H. McAlister, MD
John D. Mackenzie, MD
Stuart A. Royal, MS, MD
Andrew T. Trout, MD
Thierry A.G.M. Huisman, MD
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S15
SPR PAST PRESIDENTS, PREVIOUS & FUTURE MEETING SITES,
AWARDEES & EDWARD B. D. NEUHAUSER LECTURERS
PAST PRESIDENTS & PREVIOUS MEETING SITES
1958 Edward B. D. Neuhauser, MD Washington, D.C.
1959 Frederic N. Silverman, MD Cincinnati, Ohio
1960 John F. Holt, MD Atlantic City, New Jersey
1961 Arthur S. Tucker, MD Miami Beach, Florida
1962 John W. Hope, MD Washington, D.C.
1963 R. Parker Allen, MD Montreal, Quebec, Canada
1964 Edward B. Singleton, MD Minneapolis, Minnesota
1965 J. Scott Dunbar, MD Washington, D.C.
1966 Harvey White, MD San Francisco, California
1967 M.H. Wittenborg, MD Washington, D.C.
1968 David H. Baker, MD New Orleans, Louisiana
1969 John A. Kirkpatrick, Jr., MD Washington, D.C.
1970 Norman M. Glazer, MD Miami Beach, Florida
1971 Bertram R. Girdany, MD Boston, Massachusetts
1972 Donald H. Altman, MD Washington, D.C.
1973 Hooshang Taybi, MD Montreal, Quebec, Canada
1974 John L. Gwinn, MD San Francisco, California
1975 Lawrence A. Davis, MD Atlanta, Georgia
1976 Marie A. Capitanio, MD Washington, D.C.
1977 John P. Dorst, MD Boston, Massachusetts
1978 John P. Dorst, MD Denver, Colorado
1979 Bernard J. Reilly, MB, FRCP (C) Toronto, Ontario, Canada
1980 Walter E. Berdon, MD Salt Lake City, Utah
1981 Andrew K. Poznanski, MD San Francisco, California
1982 N. Thorne Griscom, MD New Orleans, Louisiana
1983 Virgil R. Condon, MD Atlanta, Georgia
1984 Jerald P. Kuhn, MD Las Vegas, Nevada
1985 Lionel W. Young, MD Boston, Massachusetts
1986 John C. Leonidas, MD Washington, D.C.
1987 Derek C. Harwood Nash, MD, DSc & Toronto, Ontario, Canada
Denis Lallemand, MD (ESPR, IPR’87)
1988 Beverly P. Wood, MD San Diego, California
1989 John F. O’Connor, MD San Antonio, Texas
1990 E.A. Franken, Jr., MD Cincinnati, Ohio
1991 Donald R. Kirks, MD & Stockholm, Swedan
Hans G. Ringertz, MD, PhD (ESPR, IPR ‘91)
1992 William H. McAlister, MD Orlando, Florida
1993 M. B. Ozonoff, MD Seattle, Washington
1994 Joanna J. Seibert, MD Colorado Springs, Colorado
1995 Eric L. Effmann, MD Washington, D.C.
1996 Kenneth E. Fellows, MD & Boston, Massachusetts
Paul S. Thomas, MD (ESPR, IPR ‘96)
1997 Diane S. Babcock, MD St. Louis, Missouri
1998 Charles A. Gooding, MD Tucson, Arizona
1999 Robert L. Lebowitz, MD Vancouver, British Columbia, Canada
2000 Thomas L. Slovis, MD Naples, Florida
2001 Janet L. Strife, MD & Paris, France
Francis Brunelle, MD (ESPR, IPR’01)
2002 Bruce R. Parker, MD Philadelphia, Pennsylvania
2003 Richard B. Towbin, MD San Francisco, California
2004 David C. Kushner, MD Savannah, Georgia
2005 Stuart A. Royal, MS, MD New Orleans, Louisiana
2006 George A. Taylor, MD & Montreal, Quebec, Canada
Richard Fotter, MD (ESPR, IPR’06)
2007 Marilyn J. Goske, MD Miami, Florida
2008 Marta Hernanz-Schulman, MD Scottsdale, Arizona
2009 M. Ines Boechat, MD, FACR Carlsbad, California
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S16
2010 Neil D. Johnson, MBBS Boston, Massachusetts
2011 Dorothy I. Bulas, MD & London, England
Catherine M. Owens, MD (ESPR, IPR’11)
2012 Donald P. Frush, MD San Francisco, California
2013 Sue C. Kaste, DO San Antonio, Texas
2014 Richard A. Barth, MD Washington, D.C.
2015 Brian D. Coley, MD Bellevue, Washington
2016 James S. Donaldson, MD, FACR & Chicago, Illinois
Karen Rosendahl, MD, PhD (ESPR, IPR’ 16)
2017 Diego Jaramillo, MD, MPH Vancouver, British Columbia, Canada
2018 Peter J. Strouse, MD, FACR Nashville, Tennessee
2019 Taylor Chung, MD San Francisco, California
FUTURE MEETINGS
2020 May 12 – May 16, 2020 TBD
2021 June 15 - June 19, 2021 (IPR) Rome, Italy
2022 April 27 – May 1, 2022 Denver, Colorado
GOLD MEDALISTS
1988 Frederic N. Silverman, MD
1989 John L. Gwinn, MD
1990 John F. Holt, MD
1991 John A. Kirkpatrick, Jr., MD
1991 Bernard J. Reilly, MB, FRCP
1992 Edward B. Singleton, MD
1993 Hooshang Taybi, MD
1994 Walter E. Berdon, MD
1994 J. Scott Dunbar, MD
1995 Guido Currarino, MD
1995 Derek C. Harwood Nash, MD, DSc
1996 Andrew K. Poznanski, MD
1996 Beverly P. Wood, MD
1997 N. Thorne Griscom, MD
1997 John F. O’Connor, MD
1998 William H. McAlister, MD
1999 E. A. Franken, MD
2000 Eric L. Effmann, MD
2001 Giulio J. D’Angio, MD
2002 David H. Baker, MD
2003 Brinton B. Gay, Jr., MD
2003 William H. Northway, Jr., MD
2004 Diane S. Babcock, MD
2004 Virgil R. Condon, MD
2005 Jerald P. Kuhn, MD
2005 Thomas L. Slovis, MD
2006 Robert L. Lebowitz, MD
2006 John C. Leonidas, MD
2007 Leonard E. Swischuk, MD
2008 Barry D. Fletcher, MD
2009 Charles A. Gooding, MD
2010 Janet L. Strife, MD
2011 Carol M. Rumack, MD
2012 Marilyn J. Goske, MD
2013 Stuart A. Royal, MS, MD
2014 David C. Kushner, MD
2015 George A. Taylor, MD
2016 Jennifer K. Boylan, MA
2017 M. Ines Boechat, MD
2017 Paul K. Kleinman, MD
2018 Dorothy I. Bulas, MD, FACR, FAAP
2018 Neil D. Johnson, MBBS
2019 Donald P. Frush, MD, FACR
2019 Marta Hernanz-Schulman, MD, FACR, FAAP
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S17
PIONEER HONOREES
1990 John P. Caffey, MD
1991 M. H. Wittenborg, MD
1992 Edward B. Singleton, MD
1993 Frederic N. Silverman, MD
1994 John P. Dorst, MD
1995 Edward B. D. Neuhauser, MD
1996 E. A. Franken, MD
1996 Kazimierz Kozlowski, MD
1996 M. Arnold Lassrich, MD
1997 Arnold Shkolnik, MD
1998 Heidi B. Patriquin, MD
1998 William H. Northway, Jr., MD
2000 Jerald P. Kuhn, MD
2001 Diane S. Babcock, MD
2001 Fred E. Avni, MD, PhD
2003 Walter E. Berdon, MD
2004 G. B. Clifton Harris, MD
2005 Rita L. Teele, MD
2006 Robert L. Lebowitz, MD
2007 Carol M. Rumack, MD
2008 Paul S. Babyn, MD
2009 Kenneth E. Fellows, MD
2010 David K. Yousefzadeh, MD
2011 Massoud Majd, MD
2012 George S. Bisset, III, MD
2013 Barry D. Fletcher, MD
2014 Diego Jaramillo, MD, MPH
2015 William E. Shiels, DO
2016 Mary R. Wyers, MD
2017 H. Theodore Harcke, Jr., MD
2018 Richard B. Towbin, MD, FACR
2019 Michael DiPietro, MD, FACR
PRESIDENTIAL RECOGNITION AWARDS
1999 David C. Kushner, MD
2000 Paul K. Kleinman, MD
2001 Neil D. Johnson, MBBS
2001 Christopher Johnson
2002 Jennifer K. Boylan, MA
2002 Thomas L. Slovis, MD
2003 Danielle K.B. Boal, MD
2003 Marta Hernanz-Schulman, MD
2004 Kenneth L. Mendelson, MD
2005 Taylor Chung, MD
2005 J. A. Gordon Culham, MD
2005 Shi-Joon Yoo, MD
2006 L. Christopher Foley, MD
2007 Donald P. Frush, MD
2008 Mary K. Martel, PhD
2008 Connie L. Mitchell, MA, RT(R)(CT)
2008 Harvey L. Neiman, MD
2009 Karen S. Schmitt
2010 Richard A. Barth, MD
2011 Kimberly E. Applegate, MD, MS
2011 Keith Strauss, MS, FACR
2012 David C. Kushner, MD, FACR
2012 Stuart A. Royal, MS, MD
2013 Alan E. Schlesinger, MD
2014 Richard M. Benator, MD
2015 Cynthia K. Rigsby, MD
2016 Vicente Gilsanz, MD, PhD
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S18
2017 Tal Laor, MD
2018 Joëlle A. Moreno, JD
2018 Patricia Vario
2019 A. James Barkovich, MD
2019 Patricia E. Burrows, MD
HONORARY MEMBERS
1985 Jacques Sauvegrain, MD
1987 Bryan J. Cremin, MD
1987 Ole A. Eklof, MD
1987 Clement C. Faure, MD
1987 Andres Giedion, MD
1987 Denis Lallemand, MD
1987 Arnold Lassrich, MD
1987 Ulf G. Rudhe, MD
1998 Frederic N. Silverman, MD
1989 John L. Gwinn, MD
1990 John F. Holt, MD
1990 Richard G. Lester, MD
1991 Gabriel L. Kalifa, MD
1991 Javier Lucaya, MD
1991 John P. Masel, MD
1991 Noemi Perlmutter Cremer, MD
1991 Hans G. Ringertz, MD
1991 John A. Kirkpatrick, Jr., MD
1991 Bernard J. Reilly, MB, FRCP(C)
1992 Edward B. Singleton, MD
1992 Donald R. Kirks, MD
1992 Beverly P. Wood, MD
1992 Walter E. Berdon, MD
1993 Hooshang Taybi, MD
1994 Marie A. Capitanio, MD
1994 E. A. Franken, Jr., MD
1994 John C. Leonidas, MD
1994 William H. McAlister, MD
1994 Andrew K. Poznanski, MD
1994 J. Scott Dunbar, MD
1995 David H. Baker, MD
1992 Derek C. Harwood Nash, MD, DSc
1995 N. Thorne Griscom, MD
1995 Guido Currarino, MD
1996 Francis O. Brunelle, MD
1996 Lloyd L. Morris, MD
1996 Heidi B. Patriquin, MD
1997 John F. O’Connor, MD
1997 Theodore E. Keats, MD
1998 Rita L. Teele, MD
1998 H. Ted Harcke, MD
1999 J. Bruce Beckwith, MD
2000 Joseph Volpe, MD
2001 Ulrich V. Willi, MD
2001 Henrique M. Lederman, MD
2001 Mutsuhisa Fujioka, MD
2002 Eric J. Hall, DSc, FACR, FRCR
2002 Walter Huda, PhD
2003 Michael R. Harrison, MD
2004 Lee F. Rogers, MD
2005 Carden Johnston, MD
2006 Alan B. Retik, MD
2007 Robert R. Hattery, MD
2008 Professor Hassen A. Gharbi
2009 Dolores Bustelo, MD
2009 Pedro A. Daltro, MD, PhD
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S19
2009 Cristian Garcia, MD
2009 Antônio Soares de Souza, MD
2010 Stephen Chapman, MD
2011 Catherine M. Owens, MBBS
2011 Madan M. Rehani, PhD
2012 Harvey L. Neiman, MD, FACR
2013 Savvas Andronikou, MBBCh, FCRad, FRCR, PhD
2014 Timothy M. Cain, MBBS
2015 In-One Kim, MD
2015 Professor Guy Sebag (posthumously)
2016 Bernard F. Laya, DO
2017 Gloria Soto Giordani, MD
2018 Fred E. Avni, Jr., MD, PhD
2018 Karen Rosendahl, MD, PhD
2019 Omolola (Monica) Atalabi, MD
2019 Kushaljit S. Sodhi, MD, PhD, MAMS, FICR, PIMER
EDWARD B. SINGLETON-HOOSHANG TAYBI AWARD
2006 Corning Benton, Jr., MD
2007 Michael P. D’Alessandro, MD
2007 Janet R. Reid, MD
2008 Dorothy I. Bulas, MD
2009 Lane F. Donnelly, MD
2010 Wilbur L. Smith, Jr., MD
2011 Ralph S. Lachman, MD, FACR
2012 Alan Daneman, MD
2013 Lisa H. Lowe, MD
2014 Robert H. Cleveland, MD
2015 Stephen F. Simoneaux, MD
2016 Michael A. DiPietro, MD
2017 Shi-Joon Yoo, MD
2018 John D. Strain, MD, FACR
JOHN A. KIRKPATRICK YOUNG INVESTIGATOR AWARD
This award is given to the author of the best paper presented by a resident or fellow at the SPR meeting. Beginning in 1995, the award
became known as the John A. Kirkpatrick Young Investigator Award.
1993 Philipp K. Lang, MD
1993 Stephanie P. Ryan, MD
1994 Sara O’Hara, MD
1995 Philipp K. Lang, MD
1996 Fergus V. Coakley, MB, FRCR
1997 Ronald A. Alberico, MD
1998 Laura J. Varich, MD
1999 A. E. Ensley, BS
1999 R.W. Sze, MD
2000 S. H. Schneider, MD
2001 Valerie L. Ward, MD
2002 Ricardo Faingold, MD
2003 Andrea Doria, MD
2004 Nina M. Menezes, PhD
2005 Lena Naffaa, MD
2006 Courtney A. Coursey, MD
2007 Ashley J. Robinson, MBChB
2008 Hee Kyung Kim, MD
2009 Conor Bogue, MD
2010 Albert Hsiao, MD, PhD
2011 Ethan A. Smith, MD
2012 Saivivek Bogale, MD
2013 Emma Raver, BA
2014 Aarti Luhar, MD
2015 Ashish Parikh, MD
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2016 Sila Kurugol, PhD
2017 Ezekiel Maloney, MD
2018 Arleen Li
WALTER E. BERDON AND THOMAS L. SLOVIS AWARDS - 2018
The Walter E. Berdon Award recognizes the best clinical research paper submitted to the journal of Pediatric Radiology in the year
preceding the meeting. This award was established to honor Walter E. Berdon who served as the North American Editor of Pediatric
Radiology for 30 years and who stepped down as editor on June 30, 2003.
The Thomas L. Slovis Award recognizes the best basic scientific paper submitted to the journal of Pediatric Radiology in the year
preceding the meeting. This award was established to honor Thomas L. Slovis who served as the North American Editor of Pediatric
Radiology following Dr. Berdon and who stepped down as editor on December 31, 2012.
Prior to 2012, Walter E. Berdon Awards recognized both the best clinical research paper and the best basic scientific paper.
2018 recipients will be announced at the meeting.
2017
Best Clinical Paper (Walter E. Berdon Award):
Jennifer E. Lim-Dunham, MD, FACR, Iclal Erdem Toslak, MD, Khalid Alsabban, MD, Amany Aziz, MD, Brendan Martin, PhD,
Gokcan Okur, MD, Katherine C. Longo, MD. Ultrasound risk stratification for malignancy using the 2015 American Thyroid Association
Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer.
Best Basic Science Paper (Thomas L. Slovis Award): Monwabisi Makola, PhD, M. Douglas Ris, PhD, E. Mark Mahone, PhD, Keith Owen Yeates, PhD, Kim M. Cecil, PhD. Long-term
effects of radiation on white matter of the corpus callosum: a diffusion tensor imaging study
2016
Best Clinical Paper (Walter E. Berdon Award): Rothman S, Gonen A, Vodonos A, Novack V, Shelef I (2016) Does preparation of children before MRI reduce the need for anesthesia?
Prospective randomized control trial. Pediatr Radiol 46:1599-1605
Best Basic Science Paper (Thomas L. Slovis Award):
Jarvis K, Schnell S, Barker AJ, Garcia J, Lorenz R, Rose M, Chowdhary V, Carr J, Robinson JD, Rigsby CK, Markl M (2016) Evaluation
of blood flow distribution asymmetry and vascular geometry in patients with Fontan circulation using 4-D flow MRI. Pediatr
Radiol 46:1507-1519
2015
Best Clinical Paper (Walter E. Berdon Award):
Choudhary AK, Bradford R, Dias MS, Thamburaj K, Boal DK (2015) Venous injury in abusive head trauma. Pediatr Radiol 45:1803-
1813
Best Basic Science Paper (Thomas L. Slovis Award):
Back SJ, Edgar JC, Canning DA, Darge K (2015) Contrast-enhanced voiding urosonography: In vitro evaluation of a second generation
ultrasound contrast agent for in vivo optimization. Pediatr Radiol 45:1496-1505
2014
Best Clinical Paper (Walter E. Berdon Award):
Tyson ME, Bohl DD, Blickman JG. (2014) A randomized controlled trial: child life services in pediatric imaging. Pediatr
Radiol 44:1426-1432
Best Basic Science Paper (Thomas L. Slovis Award):
Tsai A, McDonald AG, Rosenberg AE, Gupta R, Kleinman PK (2014) High-resolution CT with histopathological correlates of the classic
metaphyseal lesion of infant abuse. Pediatr Radiol 44:124-140
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S21
2013
Best Clinical Paper (Walter E. Berdon Award):
Punwani S, Cheung KK, Skipper N, Bell N, Bainbridge A, Taylor SA, Groves AM, Hain SF, Ben-Haim S, Shankar A, Daw S, Halligan
S, Humphries PD (2013) Dynamic contrast enhanced MRI improves accuracy for detecting focal splenic involvement in children and
adolescents with Hodgkin disease. Pediatr Radiol 43:941-949
Best Basic Science Paper (Thomas L. Slovis Award):
Hanquinet S, Rougemont AL, Courvoisier D, Rubbia-Brandt L, McLin V, Tempia M, Anooshiravani M (2013) Acoustic radiation force
impulse (ARFI) elastography for the non-invasive diagnosis of liver fibrosis in children. Pediatr Radiol 43:545-551
2012
Best Clinical Paper (Walter E. Berdon Award): Swanson JO1, Vavilala MS, Wang J, Pruthi S, Fink J, Jaffe KM, Durbin D, Koepsell T, Temkin N, Rivara FP (2012) Association of
initial CT findings with quality-of-life outcomes for traumatic brain injury in children. Pediatr Radiol 42:974-981
Best Basic Science Paper (Thomas L. Slovis Award):
Tkach JA, Hillman NH, Jobe AH, Loew W, Pratt RG, Daniels BR, Kallapur SG, Kline-Fath BM, Merhar SL, Giaquinto RO, Winter PM,
Li Y, Ikegami M, Whitsett JA, Dumoulin CL (2012) An MRI system for imaging neonates in the NICU: initial feasibility study. Pediatr
Radiol 412:1347-1356
2011
Best Basic Science Paper:
Castaneda RT1, Boddington S, Henning TD, Wendland M, Mandrussow L, Liu S, Daldrup-Link H (2011) Labeling human embryonic
stem-cell-derived cardiomyocytes for tracking with MR imaging. Pediatr Radiol 41:1384-1392
Best Clinical Research Paper:
Schachar JL, Zampolin RL, Miller TS, Farinhas JM, Freeman K, Taragin BH (2011) External validation of the New Orleans Criteria
(NOC), the Canadian CT Head Rule (CCHR) and the National Emergency X-Radiography Utilization Study II (NEXUS II) for CT
scanning in pediatric patients with minor head injury in a non-trauma center. Pediatr Radiol 41:971-979
2010
Best Basic Science Paper:
Goo HW (2010) Initial experience of dual energy lung perfusion CT using a dual source CT system in children. Pediatr Radiol 40:1536-
1544
Best Clinical Research Paper:
Raissaki M, Perisinakis K, Damilakis J, Gourtsoyiannis N (2010) Eye-lens bismuth shielding in paediatric head CT: artefact evaluation
and reduction. Pediatr Radiol 40:1748-1754
2009
Best Basic Science Paper:
Helm EJ, Silva CT, Roberts HC, Manson D, Seed MT, Amaral JG, Babyn PS (2009) Computer-aided detection for the identification of
pulmonary nodules in pediatric oncology patients: initial experience. Pediatr Radiol 39:685-693
Best Clinical Research Paper: Ben Saad M, Rohnean A, Sigal-Cinqualbre A, Adler G, Paul JF (2009) Evaluation of image quality and radiation dose of thoracic and
coronary dual-source CT in 110 infant with congenital heart disease. Pediatr Radiol 39:668-676
2008
Best Basic Science Paper: Wang ZJ, Boddington S, Wendland M, Meier R, Corot C, Daldrup-Link H (2008) MR imaging of ovarian tumors using folate-receptor-targeted
contrast agents. Pediatr Radiol 38:529-537
Best Clinical Research Paper:
Hallowell LM, Stewart SE, de Amorim E Silva CT, Ditchfield MR (2008) Reviewing the process of preparing children for MRI. Pediatr Radiol
38:271-279
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S22
2007
Best Basic Science Paper:
Maree GJ, Irving BJ, Hering ER (2007) Paediatric dose measurement in a full-body digital radiography unit. Pediatr Radiol 37:990-997
Best Clinical Research Paper:
Silva CT, Daneman A, Navarro OM, Moore AM, Moineddin R, Gerstle JT, Mittal A, Brindle M, Epelman M (2007) Correlation of sonographic
findings and outcome in necrotizing enterocolitis. Pediatr Radiol 37:274-282
2006
Best Basic Science Paper:
Goo HW, Suh DS (2006) The influences of tube voltage and scan direction on combined tube current modulation: a phantom study. Pediatr Radiol
36:833-840
Best Clinical Research Paper:
Lee T, Tsai IC, Fu YC, Jan SL, Wang CC, Chang Y, Chen MC (2006) Using multidetector-row CT in neonates with complex congenital heart
disease to replace diagnostic cardiac catheterization for anatomical investigation: initial experiences in technical and clinical feasibility. Pediatr
Radiol 36:1273-1282
2005
Best Basic Science Paper:
Nield LE, Qi XL, Valsangiacomo ER, Macgowan CK, Wright GA, Hornberger LK, Yoo SJ (2005) In vivo MRI measurement of blood oxygen
saturation in children with congenital heart disease. Pediatr Radiol 35:179-185
Best Clinical Paper:
Jones A, Granger S, Brambilla D, Gallagher D, Vichinsky E, Woods G, Berman B, Roach S, Nichols F, Adams RJ (2005) Can peak systolic
velocities be used for prediction of stroke in sickle cell anemia? Pediatr Radiol 35:66-72
2004
Best Basic Science Paper:
Peng SS, Lee WT, Wang YH, Huang KM (2004) Cerebral diffusion tensor images in children with tuberous sclerosis: a preliminary report.
Pediatr Radiol 34:387-392
Best Clinical Paper:
Babyn PS, Chu WC, Tsou IY, Wansaicheong GK, Allen U, Bitnun A, Chee TS, Cheng FW, Chiu MC, Fok TF, Hon EK, Gahunia HK, Kaw GJ,
Khong PL, Leung CW, Li AM, Manson D, Metreweli C, Ng PC, Read S, Stringer DA (2004) Severe acute respiratory syndrome (SARS): chest
radiographic features in children. Pediatr Radiol 34:47-58
2003
Best Basic Science Paper:
Xiang J, Holowka S, Sharma R, Hunjan A, Otsubo H, Chuang S (2003) Volumetric localization of somatosensory cortex in children using
synthetic aperture magnetometry. Pediatr Radiol 33:321-327
Best Clinical Paper:
Grattan-Smith JD, Perez-Bayfield MR, Jones RA, Little S, Broecker B, Smith EA, Scherz HC, Kirsch AJ (2003) MR imaging of kidneys:
functional evaluation using F-15 perfusion imaging. Pediatr Radiol 33:293-304
2002
Best Basic Science Paper:
Nield LE, Qi X, Yoo SJ, Valsangiacomo ER, Hornberger LK, Wright GA (2002) MRI-based blood oxygen saturation measurements in infants
and children with congenital heart disease. Pediatr Radiol 32:518-522
Best Clinical Paper:
Lamer S, Dorgeret S, Khairouni A, Mazda K, Brillet PY, Bacheville E, Bloch J, Penneçot GF, Hassan M, Sebag GH (2002) Femoral head
vascularisation in Legg-Calvé-Perthes disease: comparison of dynamic gadolinium-enhanced subtraction MRI with bone scintigraphy. Pediatr
Radiol 32:580-585
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S23
SPR RESEARCH AND EDUCATION FOUNDATION AWARDS
The SPR Research and Education Foundation is dedicated to promoting research and scholarship and education in pediatric radiology. In
2019, the REF Board of Directors announced that the Jack Haller Award for Excellence in Pediatric Radiology Education has been
renamed to be, The Jack O. Haller – Thomas L. Slovis, Award for Excellence in Pediatric Radiology Education.
As background, in 2004 Jack Haller passed away and his friend Tom Slovis asked the SPR Foundation Board of Directors to establish an
award in Jack’s memory to recognize excellence in pediatric radiology education. The Foundation Board approved the request and Tom
seeded the fund with the inaugural donation of $10,000. Tom continued to support the Haller fund in subsequent years. We hope you
agree that it is fitting that the award that celebrates excellence in pediatric radiology education, also through this renaming, now also
celebrates the lasting impact of friendship and goodwill.
THE JACK O. HALLER AWARD FOR EXCELLENCE IN PEDIATRIC RADIOLOGY EDUCATION
2005 Alan Daneman, MD
2006 William R. Cranley, MD
2006 John F. O’Connor, MD
2007 Cindy R. Miller, MD
2008 Sara J. Abramson-Squire, MD
2009 Michael A. DiPietro, MD
2010 George A. Taylor, MD
2011 Paul K. Kleinman, MD
2012 Richard I. Markowitz, MD
2013 Gary L. Hedlund, DO
2014 Tal Laor, MD
2014 Carrie B. Ruzal-Shapiro, MD
2015 Laura Z. Fenton, MD
2016 Melvin Senac, MD
2017 Janet R. Reid, MD, FRCPC
2018 Veronica J. Rooks, MD
2018 Yukata Sato, MD, PhD
THE JACK O. HALLER – THOMAS L. SLOVIS AWARD FOR EXCELLENCE IN PEDIATRIC RADIOLOGY EDUCATION
2019 Mahesh M. Thapa, MD
THE HEIDI PATRIQUIN INTERNATIONAL FELLOWSHIP
2005 Luy Lyda, MD, Angkor Hospital for Children, Siem Reap, Cambodia
2006 Hakima Al-Hashimi, MD Salmaniya Medical Complex, Manama, Bahrain
2006 Pannee Visrutaratna, MD, Chiang Mai University, Chiang Mai, Thailand
2006 Juana Maria Vallejo, MD, Clinica del Country, Bogota, Colombia
2007 Nathan David P. Concepcion, MD, St. Luke’s Medical Center, Quezon City, Philippines
2008 Rolando Reyna Lopez, MD, Hospital Santo Tomas, Panama City, Panama
2009 Ahmed Mussa Jusabani, MD, Kilimanjaro Christian Medical Centre, Moshi Town, Tanzania
2010 Omolola Mojisola Atalabi, MD, College of Medicine, University of Ibadan, Nigeria
2011 Kushaljit Singh Sodhi, MD, Postgraduate Institute of Medical Education and Research
2012 Wambani Sidika Jeska, MBchB, Kenyatta National Hospital, Nairobi, Kenya
2012 Yocabel Gorfu, MD, Addis Ababa University, Addis Ababa, Ethiopia
2013 Regina Nava, MD, St. Luke’s Medical Center, Quezon City, Philippines
2013 Olubukola Abeni Omidiji, MBBS, University of Lagos, Lagos, Nigeria
2014 Nneka I. Iloanusi, MBBS, University of Nigeria Teaching Hospital, Enugu, Nigeria
2014 Beatrice Mulama, MBChB, M. Med, Kenyatta National Hospital, Nairobi, Kenya
2015 Nasreen Mahomed, MBBCh, University of the Wiwatersand, Johannesburg, Gauteng
2015 Waseem Akhtar Mirza, MBBS, The Aga Khan University, Karachi, Pakistan
2016 Daniel Zewdneh Solomon, MD, Addis Ababa University, Addis Ababa, Ethiopia
2016 Vikas Yadav, MD, Christian Medical College, Vellore, Tamilnadu, India
2017 Hatíce Ariöz Habíbí, MD, Cerrahpasa Medical, Istanbul University, Turkey
2017 Faizah Mohd Zaki, MD, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
2018 Bernadette Wambui Muthee, MD, Aga Khan University Hospital, Nairobi, Kenya
2019 Fathia Omer Salah, MD, Black Lion Hospital, Addis Ababa, Ethiopia
2019 Sunder Suwal, MD, University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S24
SPR RESEARCH AND EDUCATION FOUNDATION GRANTS
The 2018 grant recipients are listed. 2019 grant recipients will be announced at the meeting. For grants from prior years, please see
the SPR website.
EDUCATION PROJECT AWARD
"Child Abuse Radiology: Report, Research and Teaching Tool – CAR3T2" - Jeannette M. Perez-Rossello MD, Boston Children’s Hospital
JOHN DORST-FELIX FLEISCHNER SEED GRANT AWARDS
“Utility of Respiratory Gated Dynamic Volumetric CTA in the Awake State Compared to Non-Gated Dynamic Volumetric CTA and
Bronchoscopy in Pediatric Patients With Suspected Proximal Airway Obstruction”- Anna Lillis, MD, Nationwide Children's Hospital,
Columbus, OH
“Automated Image Quality Assessment Utilizing Machine Learning in Clinical Chest Projection Imaging in Young Children”
- Gary Schooler, MD, Duke University, Durham, North Carolina
MULTI-INSTITUTIONAL PILOT AWARD
“Contrast-Enhanced Brain Ultrasound in Extreme Premature Fetal Lambs Maintained by the EXTra-uterine Environment for Neonatal
Support (EXTEND): Evaluation of Perfusion Parameters and Assessment of Intracranial Pressure" - Ryne A Didier, MD, Children’s
Hospital of Philadelphia
"A Pilot Study to Assess if fMRI is a Potential Radiological Biomarker in Youth with Persistent Concussion Symptoms"
- Jessie Aw-Zoretic, MBChB, Lurie Children’s Hospital, Chicago
"Zero Echo-Time MRI for Radiation Free Pediatric Bone Imaging" - Mai-Lan Ho, MD, Mayo Clinic, Rochester, Minnesota
SEED GRANT
"Integrative Imaging Biomarker Assessment of Hepatic Involvement and Severity in Gaucher Disease to Tailor Personalized Therapy"
- Andrew Degnan, MD, MPhil, Children’s Hospital of Philadelphia
YOUNG INVESTIGATOR
"High Performance Engine for Dose-Reduced CT Imaging System" - Xiao Wang, PhD, Boston Children's Hospital; Mentor: Simon
Warfield
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S25
PREVIOUS EDWARD B. D. NEUHAUSER LECTURES
1971- John Caffey, MD, Pittsburgh, Pennsylvania: "The Radiologist and Unexplained Injury to Infants: Early History and Current Status"
1972- M. Judah Folkman, MD, Boston, Massachusetts: "Patterns of Discovery Fundamental to Radiology and Biology"
1973- Josef Warkany, MD, Cincinnati, Ohio: "Pediatric Radiology and Syndromology"
1974- Benjamin H. Landing, MD, Los Angeles, California: "Syndromes of Congenital Heart Disease with Tracheobronchial Anomalies"
1975- Frederic N. Silverman, MD, Cincinnati, Ohio: "Viral Diseases of Bone Do They Exist?"
1976- Lynne M. Reid, MD, Boston, Massachusetts: "The Lung Its Growth and Remodeling in Health and Disease"
1977- John F. Holt, MD, Ann Arbor, Michigan: "Neurofibromatosis in Children"
1978- Helen B. Taussig, MD, Baltimore, Maryland: "The Tetralogy of Fallot"
1979- Robert B. Salter, MD, Toronto, Ontario, Canada: "Legg Perthes Disease: The Scientific Basis for the Various Methods of Treatment and
Their Indications"
1980- C. John Hodson, MD, New Haven, Connecticut: "Reflux Nephropathy and the Pediatric Radiologist"
1981- Stanley M. Garn, Ph.D., Ann Arbor, Michigan: "Contributions of the Radiographic Image to the Understanding of Human Growth"
1982- Duncan V. B. Neuhauser, Ph.D., Cleveland, Ohio: "Careful Thinking"
1983- J. Bruce Beckwith, MD, Seattle, Washington: "Renal Tumors of Children Pathologic Considerations Relevant to Diagnostic
Imaging"
1984- J. Scott Dunbar, MD, Cincinnati, Ohio: "The Accessory Nasal Sinuses"
1985- John A. Kirkpatrick, Jr., MD, Boston, Massachusetts: "The Neuhauser Legacy"
1986- Kurt Hirschhorn, MD, New York, New York: "Recent Advances in Prenatal Diagnosis of Genetic and Congenital Disease"
1987- Andres Giedion, MD, Zurich, Switzerland: "Radiological Syntax of Genetic Bone Disease"
1988- Joseph J. Volpe, MD, St. Louis, Missouri: "Brain Injury in the Premature Infant"
1989- David H. Baker, MD, New York, New York: "Personal Reflections on Men and Machines from Red Goggles to Spin Wobbles"
1990- William H. Northway, Jr., MD, Stanford, California: "Bronchopulmonary Dysplasia and Research in Diagnostic Radiology"
1991- Derek C. Harwood Nash, MD, DSc, Toronto, Canada: "Pediatric Neuroimaging: The Evolution and Revolution of a Sub Specialty"
1992- Walter E. Berdon, MD, New York, New York: "Diseases of the Bone Marrow: MRI Observations"
1993- Morrie E. Kricun, MD, Philadelphia, Pennsylvania: "Paleoradiology: A Look into the Past"
1994- Beverly Wood, MD, Los Angeles, California: "Acute Pulmonary Disease in the Compromised Child"
1995- Frances S. Collins, MD, PhD, Washington, DC: "The Human Genome Project and the Future of Medicine"
1996- M. Judah Folkman, MD, Boston, Massachusetts: “Clinical Applications of Angiogenesis Research”
1997- S. Steven Potter, PhD, Cincinnati, Ohio: “Homeobox Genes and Pattern Formation (Master Genes)”
1998- Roy A. Filly, MD, San Francisco, California: “Fetal Thoracic Surgery”
1999- Harold A Richman, PhD, Chicago, Illinois: “Child Abuse: From a Radiologist’s Discovery to a Major Issue of Public Policy. What
Have We Wrought?”
2000- William D. Lyman, PhD, Detroit, Michigan: “Prenatal Molecular Diagnosis and Fetal Therapy”
2001- Jerry R. Dwek, MD, Columbus, Ohio: “Médecins Sans Frontiéres/The Doctors Without Borders Experience – Afghanistan”
2002- Eric J. Hall, DSc, FACR, FRCR, New York, New York: “Lessons We Have Learned From Our Children: Cancer Risks From
Diagnostic Radiology”
2003- Jeffrey A. Towbin, MD, Houston, Texas: “Molecular Cardiology: Laboratory to Bedside”
2004- Bruce R. Rosen, MD, PhD, Boston, Massachusetts: “New Advances in MRI: A Guide for the Practicing Pediatric Radiologist”
2005- Bruce R. Korf, MD, PhD, Birmingham, Alabama: “Pathobiology and Management of NF1 in the ‘Genomic Era’”
2006- Richard M.J. Bohmer, MD, MPH, Boston, Massachusetts: “Evolution, Innovation and the Changing Nature of Healthcare Delivery”
2007- Nogah Haramati, MD, Bronx, New York: “21st Century Radiology: Growth and Development of Our Workflows and Processes”
2008- Emanuel Kanal, MD, FACR, FISMRM, AANG, Pittsburg, Pennsylvania: “MR Technology: Where Are We, Where Are We Going?
2009- Roberta G. Williams, MD, Los Angeles, California: “Cardiology and Radiology: Partners in Producing Healthy Adults with Congenital
Heart Disease”
2010- Regina E. Herzlinger, PhD, Boston, Massachusetts: “The Economic Basis of Change in Healthcare”
2011- Sanjiv Gambhir, MD, PhD, Stanford, California: “Molecular Imaging”
2012- William R. Hendee, PhD, Milwaukee, Wisconsin: “Past and Future Patient Benefits of Radiologist/Physicist Collaboration”
2013- James R. Downing, MD, Memphis, Tennessee: “The Pediatric Cancer Genome Project – Implications for Clinical Medicine
2014- Robert Pearl, MD, Oakland, California: “The Future of American Medicine – The Impact of Health Care Reform”
2015- Robert J. Gillies, PhD, Tampa, Florida: “Radiomics and Radiogenomics”
2016- Scott E. Fraser, PhD, Los Angeles, California: "Multimodal Imaging of the Molecular, Cellular and Tissue Events Underlying
Embryonic Development”
2017- James H. Thrall, MD, FACR, Boston, Massachusetts: “Roles for Imaging in the Age of Precision Medicine”
2018- Paul K. Kleinman, MD, FAAP, Boston, Massachusetts: Curious Bones: Sustaining Discovery in the Face of Doubt
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S26
SPR 2019 HONOREES
SPR 2019 GOLD MEDALIST
The Gold Medal of The Society for Pediatric Radiology is our most distinguished honor. The SPR Gold Medal is awarded to pediatric
radiologists who have contributed greatly to the SPR and our subspecialty of pediatric radiology as a scientist, teacher, personal mentor
and leader.
Donald P. Frush, MD, FACR
“Don is a compelling visionary. His focus on radiation dose many years ago has been transformative to the practice of pediatric
radiology.”
- George Bissett, MD
The Society for Pediatric Radiology is most fortunate to have unusually dedicated and talented members who speak on behalf of children.
One of these individuals is Donald P. Frush, MD, who through his passion and scientific achievements has been one of the leading voices
for our Society both nationally and internationally since joining the SPR in 1992. Don’s voice is always calm and substantive, and he has
represented our specialty with the highest of ethics and humility.
Don was born in upstate New York in 1958. He had an idyllic childhood in the small community of Los Gatos, California where his
family moved when he was 5 years old. His father was an IBM engineer and his mother was dedicated to raising their four children. He
describes his parents as “very progressive, enlightened about the environment and dedicated to diversity and inclusiveness”.” As a boy,
he loved camping and sports (tennis, basketball…really any sport) with his three siblings (one older sister and two younger brothers). As
an undergraduate at the University of California- Davis, he majored in psychology but found himself drawn to working with children. He
decided to enter medical school at Duke University where he met his wife Karen. They married his senior year of medical school. During
a two-year pediatric residency at University of California- San Francisco, pediatric radiologists Charles Gooding, Robert Brasch and
Hooshang Taybi were influential in Don’s ultimate career choice of Pediatric Radiology. By serendipity, the Duke Radiology residency
had an unmatched position and Don started his radiology training there in 1987. Eric Effmann, MD, past-President of the SPR remembers
Don and Karen well upon their return to their medical alma mater in Durham. Eric says, “Now, more than 30 years after meeting them,
they stand as role models as academic physicians…their life and their work is inextricably linked.”
Don is driven by “doing what needs to be done”. He believes his success (when you can get him to talk about it!) has been “fortuitous”
and due to his being surrounded by great people. During his fellowship at Cincinnati Children’s Hospital Medical Center, “there was a
sense that you do the right thing for the patient that is right in front of you.” He found critical colleagues in Lane Donnelly and George
Bissett, two other innovative pediatric radiology leaders. George describes Don as “a leader, he has great strength in building consensus.
If leadership is defined by results, Don is at the top of the class!”
In 2001, an article was published on the front page of the newspaper USA TODAY, with the headline “CT scans in children linked to
cancer”. The same year, Don and Dr. Annie Paterson looked at pediatric CT scans performed at outside hospitals and found that the
radiation dose for children was not reduced compared to adults. This pivotal publication was published alongside a second article by
Donnelly, Frush and colleagues from Cincinnati on strategies to minimize radiation dose at a large children’s hospital, with an
accompanying editorial by AJR Editor Dr. Lee Rogers. Dr. Rogers later told Don that publishing those two articles was one of the most
significant contribution he had made as editor. These two frequently cited articles provided quantifiable evidence that change was needed
to improve patient safety in pediatric CT. In 2002, Dr. Tom Slovis, one of Don’s mentors, organized a revolutionary conference that
included radiologists, medical physicists, industry and government and published the proceedings in the journal, Pediatric Radiology.
Don says that, “through these events, I was literally thrown into the field of radiation protection”.
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In 2000, he and Dr. Ehsan Samei, Professor of Medical Physics at Duke began performing translational research in pediatric CT dose
reduction utilizing MOSFET technology that while basic was “always grounded in kids”. Ehsan tells us “Don is an outstanding human
being! In spite of how good he is as a clinician and as a scientist, he cares deeply and passionately about each person. This is what makes
him exceptional.”
During his 26 years of faculty at Duke, Don has been Professor of Radiology and Pediatrics, Chief of the Division of Pediatric Radiology
and the John Strohbehn Distinguished Professor of Radiology. He has written over 300 scientific articles, 43 book chapters and 14 grants.
To highlight just several of his honors, Don received the SPR Young Investigator award, the Caffey award, the SPR Presidential
Recognition award, an RSNA Editorial Fellowship and was an Associate Editor of Radiology and an Assistant Editor of Pediatric
Radiology. He is past-President of the SPR. He has been a consultant to the International Atomic Energy Agency, the World Health
Organization, Trustee and Chair of the American Board of Radiology and is Chair of the Image Gently Alliance.
When I asked Don what he was most proud of in his career, he did not speak of his accomplishments in medicine; rather he spoke of his
wife and four children. “By far, my wife and my children are my legacies.” His wife Karen is the Chief Quality Officer at Stanford
Healthcare in California, where she and Don recently moved. In her words “It’s the combination of things he’s accomplished—he is a
global leader in radiation reduction in kids, an award-winning teacher and scholar, a dedicated radiologist and mentor, a committed and
loving husband, and a father who’s been very involved in the lives of all four of our kids.” All four of their children, (Sarah, Ben, Jack
and Jenna) will or have graduated from Duke or UNC Medical School. The oldest, Sarah, admires “his integrity, his graciousness”. Jack,
a radiology intern, said his Dad taught him about “patience”. Karen elaborated on this trait, telling us that this ‘over the top’ sports fan
waited 27 years for Pittsburgh Steelers football tickets!
Don has many outside interests. Don is a farmer and loves tractors. A medical meeting had to be cut short because Don had to go home
for a farming emergency…some of their cows broke through a fence and were having a “drive” down the local road.
Don, yes, your family is your legacy, but you have also given us in pediatric radiology the strongest of legacies…to be the voice for
quality care for children. For this lasting message from you to our Society, we thank you and are grateful to you for all of your work,
compassion and contributions to our specialty and are so pleased to honor you with the Society’s highest honor, the Society for Pediatric
Radiology’s Gold Medal.
Marilyn J. Goske, MD, FACR
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SPR 2019 GOLD MEDALIST
Marta Hernanz-Schulman, MD, FACR, FAAP
The Gold Medal of The Society for Pediatric Radiology is our most distinguished honor. The SPR Medal is awarded to pediatric radiologists
who have contributed greatly to the SPR and our subspecialty of pediatric radiology as a scientist, teacher, personal mentor and leader.
“Leadership is the capacity to translate vision into reality”
– Warren Bennis
Marta Hernanz-Schulman, MD, FAAP, FACR, Professor of Radiology and Pediatrics, Chief of Pediatric Radiology at the Monroe Carell
Jr. Children’s Hospital at Vanderbilt has had a remarkable career as a leader, researcher and mentor. Her path to the field of medicine was
challenging, but she took advantage of each curve that eventually led her to her success as a leader in quality and safety as well as a
renowned expert in pediatric GI and GU imaging.
Marta was born in Cuba and came to the United States during the time of the Peter Pan airlift, between the Bay of Pigs invasion and the
1962 missile crisis. She was fortunate in being able to travel with her aunt who was able to join her two grown children in New York City;
as others who left Cuba in similar circumstances, they were allowed to bring no physical possessions. Thus, at the young age of 10
speaking no English, Marta began her new life in the US with her aunt and cousins in Brooklyn, who worked several jobs in order to make
ends meet. She attended fifth grade as an auditor, graduating from grammar school with a good command of the English language and a
grade point average of 98+. Marta never saw her father again and was separated from her mother for over 8 years.
Coincident with Marta’s start of High School at Bishop McDonnell Memorial, her cousins moved to Spain to continue their dreams of
finishing medical school that they had begun in Cuba. At the end of her sophomore year, Marta left her school to spend a year in Salamanca
with her aunt and cousins. She spent that year studying Spanish and French classics. That year her mother was able to leave Cuba for Spain
and finally was reunited with her daughter.
Marta returned to Brooklyn after a year in Spain, and with the help of a teacher/mentor was able to complete her High School work within
a three-year time span, and graduate with her classmates. The same mentor encouraged her to work toward her dream to become a physician
and broaden her horizons beyond the immediate neighborhood by applying to the Ivy Leagues. Marta was accepted to Princeton in the first
class of women. Upon graduation from Princeton, she attended medical school at NYU. As a freshman, she met her beloved husband Gerald
Schulman, a fellow student. They married at graduation and stayed in NYC for residency – he to complete internal medicine and she to
complete pediatrics at Mt Sinai Hospital. She finished her Pediatric residency and became Pediatric Board certification.
Marta began looking for options for specialization in Boston, as Gerry had accepted a fellowship in Nephrology at the Brigham. After
weighing other options, she interviewed with the Radiology Chair at Boston University, Jerome H. Shapiro, who, impressed with her
clinical credentials, accepted her on the spot, indicating that she could subspecialize in Pediatric Radiology at Boston Children’s Hospital
after her residency. She became Chief Resident at Boston University, and was subsequently chosen as Chief Fellow by John Kirkpatrick
when she began her fellowship at Boston Children’s. Her classmates included George Taylor, Fred Hoffer, and Stephen Done. Rita Teele,
Ken Fellows, Thorne Griscom, Roy Strand, John Kirkpatrick and Bob Lebowitz were among her mentors and role models.
Gerry and Marta moved back to NYC, where Marta worked at NYU with Nancy Genieser and Mike Ambrosino, whom she considers
colleagues and friends for life. During that time, Marta was responsible for radiology at Bellevue Hospital and integrated ultrasound into
the Pediatric Radiology department. During her first year there, she received new faculty teacher award, and in the second year was named
Teacher of the Year by the Pediatric house staff.
In 1988, Marta and Gerry were recruited to Vanderbilt, where Gerry became the Director of Dialysis and End Stage Renal Disease. The
Chief of Pediatric Radiology at Vanderbilt, Richard M. Heller, welcomed Marta as a faculty member. She later became Chief of Pediatric
Radiology, helping lead the department into a full service multimodality Department in a freestanding children’s hospital. She helped build
pediatric subspecialists in all areas, including Neuroradiology, MSK and IR, because “children deserve the best that we can provide.” At
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Vanderbilt within two years, she was promoted to Associate Professor with tenure, and became a full Professor five years later.
Marta’s work with the SPR began early in her career. Bob Lebowitz and Joanna Siebert asked Marta to join the Publications Committee
of the Society for Pediatric Radiology in 1994. Marta did a superb job renegotiating contracts with Springer and as Chair of the committee
for two terms helped direct the searches that led to Tom Slovis and subsequently Peter Strouse to become Editors of Pediatric Radiology.
She served as a member of the SPR Board of Directors from 1999-2002. Marta’s work ethic and organizational skills resulted in numerous
committee appointments including the Practice Standards, Bylaws, Finance, Program, and Corporate Relations, and was elected to a second
term on the Board as Second Vice President in line to the presidency. During David Kushner’s presidency she helped to reorganize the
committee structures, and became the leader of the Clinical Practices Initiative from 2004-2007. She served as Vice President of the SPR
Research and Education Foundation and as President and Chair of the Board of the SPR from 2007-2009.
Through her long career in the ACR, Marta has always worked towards the welfare of the pediatric patient, espousing the mission of the
SPR. Marta began her ACR career on the Ultrasound committee at the invitation of Carol Rumack, and later worked with Marilyn Siegel
on the DXIT In-Service examination, where she continues to chair the Pediatric section. As a member of the Pediatric Commission of the
ACR, she chaired the Pediatric Committee on Guidelines and Standards (now Parameters) and in that role helped to develop the mechanism
for the collaborative ACR-SPR guidelines used today. She has served in the Executive Committee of the Intersociety Conference, and the
Ultrasound Accreditation Committee. During her time in the ACR she worked with other members, including the members of the
Ultrasound Accreditation Committee and the Pediatric MR committee, to ensure that work done for children in pediatric hospitals is
recognized during the accreditation process. She was a member of the Commission on Education and chaired the Skills Assessment
Committee, of which the In-Service examination is a part. She succeeded Don Frush as the second Chair of the Pediatric Commission of
the ACR, serving on its Board of Chancellors for six years. During that time, she contributed the perspective of the pediatric radiologists
to the deliberations of the Board, and worked with pediatric radiologists, such as Richard Barth, in Advocacy for pediatric patients and
pediatric radiologists through the ACR. She also served in the Fellowship Committee, the Honors Committee and the Audit committee of
the ACR. As Chair of the Pediatric Commission, she also started and chaired the Pediatric Rapid Response Committee, which has created
over 300 pediatric Appropriate Use Criteria (AUC) for use in pediatric computerized decision support. She currently serves as the elected
Vice-President of the ACR within the Board of Chancellors, and as a member of its Executive Committee.
Marta has also been active in the ABR over the years, serving as a Board Examiner, contributing to exam development, and serving as the
Chair of the Pediatric MOC Committee, receiving a Lifetime Achievement Award.
Marta was one of the first critical members of the Image Gently Campaign and its Steering Committee and led the incredibly successful
“Pause and Pulse” fluoroscopy campaign. Marta understood the power and concept of Image Gently right away. Her campaign was well
conceived, using marketing techniques (Pause and Pulse on radiation badges…her idea!) and organizing and creating web content, scientific
papers, presentations and numerous collaborations. She spoke vividly and passionately at an FDA meeting on the need for radiation
protection in fluoroscopy for children. This resulted in that campaign receiving recognition from an online publication for its reach and
efficacy; the campaign and the pediatric radiologists who worked with Marta received the Minnies Award for Most Effective Philanthropy
campaign in 2011. Marta was also one of the original founding members of the Image Wisely Campaign, asked by Dr. Richard Baron to
represent the RSNA in the original discussions that resulted in Image Wisely.
Marta’s energies have not been limited to committee leadership. As a researcher and scholar she has authored or co-authored over 140 peer
reviewed articles, served as co-editor of Caffey’s Pediatric Diagnostic Imaging, authored over 50 book chapters, clinical tapes and web
courses, and given nearly 200 scientific presentations and invited lectures. She is currently a member of the Editorial Board of the journal
Pediatric Radiology, and served for ten years in the Editorial Board of Radiology. She has been the recipient of 13 grants and has received
awards for her work including the Caffey Award for Best Research in Pediatric Radiology.
Marta lost her beloved husband of 39 years, Gerald Schulman in 2016 to an unexpected illness. A Professor of Medicine he served as co-
director of the Vanderbilt Clinical Trials Center. His compassionate and thoughtful care led to the establishment of the Gerald Schulman
Lectureship by his trainees in his honor. Their son Alan in her own words “is her greatest personal achievement.” They love to travel and
remain close as he continues with his career in computer science.
"If you work hard enough and assert yourself, and use your mind and imagination, you can shape the world to your desires."
– Malcolm Gladwell
Through the many years of service, challenges and opportunities, Marta has never lost sight of her primary mission: “to provide the best
possible care to all patients, to advance medical knowledge with the North Star of advancing and improving patient care, and placing the
welfare of the patient above all other concerns.” A true star, she serves as a unique role model for excellence, service, diversity and
advocacy inspiring our specialty to reach for the stars as she has done so successfully.
Dorothy I. Bulas, MD, FACR, FAAP
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SPR 2019 PIONEER AWARD
Pioneer Honorees were first acknowledged in 1990 as a means to honor certain physicians who made special contributions to the early
development of our specialty. The Pioneer Award now honors individuals who have advanced pediatric radiology through innovation,
forethought and leadership.
Michael DiPietro, MD, FACR
Meet Michael DiPietro the 2019 Pioneer Awardee of the SPR.
In 1984, while a junior staff member at The University of Michigan, CS Mott Children’s Hospital, Mike introduced ultrasound of the spinal
canal to the SPR and received the Caffey Silver Award. His subsequent contributions to neurosonography have led to our knowledge of
Periventricular Leukomalacia (PVL), sonography of white matter including first report of the peri-trigonal echogenic blush and use of
intraoperative ultrasound to evaluate Chiari I and II malformation. One of his most cited papers is the 1993 Radiology article “The conus
medullaris: normal US findings throughout childhood”. After decades of clinical experience and investigation including extensive
presentations and publications, his accumulation of knowledge led to the co-authorship of the 2006 ACR Practice Guideline for Performance
of an Ultrasound Examination of the Neonatal Spine. In 2007, he was part of the initiative to merge ACR/AIUM guidelines to the combined
Guideline for Performance of Neurosonography. His work has had significant impact on the way neurosonography is practiced throughout
the world. In fact, in 2012, he received one of two annual University of Michigan Medical School Dean’s Lifetime Achievement Awards
for Excellence in Clinical Care; the nomination was proposed by Neurosurgery.
But wait, isn’t Mike DiPietro the Educator who received the SPR 2016 Singleton-Taybi Excellence in Education Award? And in 2009, the
Jack O. Haller Award for Excellence in Teaching? He certainly is that person, known at the University of Michigan Medical School and
Mott Children’s Hospital for dedication to radiology education at all levels, including the pediatricians to whom he relates so effectively
since he was one at Pittsburg Children’s before coming to Pediatric Radiology by way of Yale (Residency) and Boston Children’s
(Fellowship). Among numerous awards and recognitions at Michigan was his 2005 naming as the Inaugural John F. Holt Collegiate
Professor of Radiology.
Surely, you will want to meet Mike DiPietro the Producer/Director who as Co-Director of the Musculoskeletal Ultrasound Society has
staged courses around the world. From Abu Dhabi to Singapore and Brazil to Israel the society’s programs have fostered the development
of musculoskeletal ultrasound for adults and children. MSUS courses are known for their balance of lecture and student “hands-on”
scanning under the eyes of expert instructors. The dual projection of video patient scan and real time image display has become a standard
for teaching musculoskeletal ultrasound.
Before you are finished, you should meet Mike DiPietro the musician. Lest you think this was not connected to his medical career, he once
lectured on "Brains, bassoons, and other interesting things" as Visiting Professor at Boston Children’s. His fascination with the double reed
began after being “drafted” in elementary school. A love of music continued through high school and college (Union) but went through a
hiatus in his early medical career. Pediatric radiologist Jack Lawson challenged him to return to the bassoon in 1987 and from then on
lessons, practice and performance have been an important part of his life. U of M affiliated symphonies (including the University of
Michigan Life Sciences Orchestra where he was the principal bassoonist and a founding member) benefit from his dedication to performing.
Mike notes that whether teaching or presenting a lecture, one is communicating, just as one does when performing music or a play.
The many Mike DiPietros blend together to produce a man of academic competence, dedication to our subspecialty and most importantly
to the children and families we serve. While small in physical stature and quietly humble in manner, Mike stands shoulder-to-shoulder with
his mentors, who include such familiar names as Girdany, Oh, Young, Kirkpatrick and Holt. In addition, his education included contact
with Drs. Caffey and Neuhauser, a claim few can make. How does he handle the many facets of his busy multi-persona life? … By talking
and traveling with Alice, his wife of 45 years, and walking his often-photographed West Highland Terriers (Howie, Bertie and Robin).
H. Theodore Harcke, MD, FACR, FAIUM
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S31
SPR 2019 PRESIDENTIAL RECOGNITION AWARD
The Society bestows Presidential Recognition Awards on members or other individuals whose energy and creativity have made a significant
impact on the work of the Society and its service to its members.
A. James Barkovich, MD
The SPR Presidential Recognition is awarded to A. James A Barkovich. This award recognizes his fantastic career and life-long contribution
to the development and advancement of the subspecialty of pediatric neuroradiology. Numerous patients have benefited from his insightful
and timely diagnoses. Our Society and our membership have benefited from all his teachings in prior SPR meetings and all his academic
publications. His clinical and research works epitomize the mission of SPR: to foster excellence in the imaging care for pediatric patients.
James (Jim) grew up in the Bay area of San Francisco during the tumultuous time of the Vietnam War. He graduated from Redwood High
School where he was an outstanding athlete as well as a student. He continued his education at U.C. Davis where he not only graduated
Magna Cum Laude with a major in Chemistry but also was a two-year starter at point guard on the Division 1 varsity basketball team and
a decathlete on the track team. Following graduation, Jim began work on a Ph.D. in Organic Chemistry at University of California at
Berkeley. It was here that Jim met his future wife Karen. After less than 3 years, Jim had already passed his Oral Defense and had only to
write up his dissertation. By then, however, he had been accepted to George Washington University School of Medicine and his career
changed course.
Jim was accepted for an Army scholarship (rising to the rank of Major); and following graduation at GW, he began his Post Graduate
training in Radiology at Letterman Army Medical Center in San Francisco. It was during his residency, which included rotations at UCSF
Medical Center that he fell in love with Neuroradiology. In 1984, Jim began a two-year fellowship in Neuroradiology at the Walter Reed
Medical Center in Washington, D.C. During his second year, Jim focused on Pediatric Neuroradiology; he spent time at The Johns Hopkins
Hospital, Children’s Hospital National Medical Center, and The Hospital for Sick Children in Toronto.
Following the completion of his fellowship, Jim returned to Letterman Army Medical Center to head up Neuroradiology while also having
a joint appointment at UCSF in the section of Neuroradiology. Once his Army commitment had been fulfilled, Jim accepted a full-time
faculty position at UCSF in 1989.
Jim brought the science to Pediatric Neuroimaging. He utilized the emerging imaging technology of magnetic resonance and his
background as a scientist to combine the science of neurobiology and neuroembryology with imaging. He helped us to understand not just
how the normal and abnormal pediatric brain and spine appear on imaging, but also how the brain and spine develop and why they appear
the way they do.
Jim has achieved an exhaustive list of honors and awards over his distinguished career. Among them: the Founder, the President, and the
first Gold Medal awardee of the American Society of Pediatric Neuroradiology, the President of the American Society of Neuroradiology,
and the Chairman of the Board of Trustees, Neuroradiology Education and Research Foundation. He has served on numerous Editorial
Boards and served on and chaired numerous international, national, regional, and local committees.
Jim has an astounding 465 publications. His paper titled, CT and MR of profound perinatal and infantile asphyxia, published in 1992
in the American Journal of Neuroradiology was named one of the 10 best neuroradiology papers of the century in 2000. His landmark
textbook Pediatric Neuroimaging is in its sixth addition, a testament to the role it continues to play in our specialty. Jim has also won a
number of teaching awards and has been an invited speaker in every continent of the globe. By a quick count on his CV, he has lectured in
28 different countries. As if all of this were not enough, Jim has somehow managed to find the time to coach Jr. League basketball and
High School track. Some of his most enjoyable times came coaching the teams in which Karen and Jim’s three sons played on.
Steven K. Sargent, MD
Taylor Chung, MD
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SPR 2019 PRESIDENTIAL RECOGNITION AWARD
Patricia E. Burrows, MD
This SPR Presidential Recognition is awarded to Patricia E. Burrows. This award recognizes her fantastic career and life-long dedication
to the image-guided treatment of patients, in particular, with vascular malformations and hemagiomas, and patients with cardiovascular
and neurovascular diseases. Besides numerous patients whom she has positively altered their lives, our Society and our membership have
also benefited from all her teachings at past SPR meetings and her numerous academic publications. Her clinical and research works
epitomize the mission of SPR: to foster excellence in pediatric health care through imaging and image-guided care.
Pat grew up in southern Manitoba, Canada, and received her MD at the University of Manitoba Faculty of Medicine in 1976. She started
in a pediatric residency but switched to radiology after 1 year and completed her residency in Winnipeg, Manitoba in 1981. She completed
a fellowship in pediatric radiology at Winnipeg Children’s Hospital, under the mentorship of Martin Reed and Rod McPherson. She enjoyed
doing extra angiography during her residency, as well as a rotation in the cardiac Cath Lab at Children’s Hospital. This led to a second
fellowship in what was called “pediatric special procedures” including congenital heart disease, angiography, and neuroradiology at
Children’s Hospital Boston, Harvard Medical School in 1982. She was assigned a research project correlating angiographic findings with
John Mulliken’s new classification of vascular anomalies.
After her fellowship, she moved with a group of cardiovascular surgeons to Arkansas Children’s Hospital in Little Rock. This was short-
lived because of her immigration status and she took a position at The Hospital for Sick Children’s Hospital in Toronto in 1983, as head of
cardiac radiology. She performed pediatric cardiac catheterizations and cardiac interventions and developed pediatric cardiac MRI locally.
She continued practicing general pediatric radiology and angiography and then became involved in pediatric neuroimaging. While in
Toronto, she met Pierre Lasjaunias, a French neuro- interventionalist who was recruited to train the neuroradiologists at the Toronto Western
Hospital in neuro-interventional techniques. Lasjaunias agreed to train Pat in Paris and she spent seven months with him in 1985 to 86
where she learnt learned even more about vascular anomalies, neurovascular anatomy and interventional techniques. In this pre-micro
catheter era, she modified the adult techniques for the pediatric patients including embolization of arteriovenous fistula using detachable
balloons, coils and glue, as well as ethanol and sodium tetradecyl sulfate sclerotherapy for venous and lymphatic malformations. She also
had the opportunity to work with Dr. Colapinto and subsequently published the first series of pediatric trans-jugular liver biopsies and the
first case report of embolization for pediatric traumatic priapism. She was also the first person to use platinum fiber micro coils in Canada
and the first to perform renal artery stenting (with Chet Rees) in a child.
In 1994, Pat was recruited to Boston Children’s Hospital as chief of Pediatric Interventional Radiology. With this move, she decided to
give up cardiac imaging in order to focus on vascular anomalies. With John Mulliken, plastic surgeon, and Judah Folkman, vascular
scientist, Pat was a cofounder and subsequent codirector of the Vascular Anomalies Center [VAC] at Boston Children’s Hospital. She
realized very early on the importance of a multidisciplinary team for optimizing both the work-up and the therapeutic alternatives in the
field of vascular congenital anomalies. This VAC became the model for many other institutions for the treatment of patients with vascular
anomalies. Her motto in congenital vascular anomalies was straight forward "you cannot treat if you don't understand the lesion".
She became a member of the International Society for the Study of Vascular Anomalies [ISSVA] in 1994, and served on the Board of
Directors from 2006 to 2014, and as president from 2010 to 2012. While in Boston, Pat began using doxycycline to treat cystic lymphatic
malformations and subsequently showed that it was safe and effective to use in infants. She trained many fellows and residents, and two of
them, Ahmad Alomari and David Lord, went on to direct Vascular Anomalies programs themselves.
In 2006, Pat left Boston Children’s after 13 years and joined Alejandro Berenstein at his vascular anomalies center in Roosevelt Hospital
in New York City. This was a very fruitful relationship. Missing the pediatric culture of large children’s hospitals, Pat decided to relocate
to Houston, Texas, as chief of pediatric interventional radiology at Texas Children’s Hospital, Baylor College of Medicine in 2009. She
also spent one year at Memorial Hermann Hospital in Houston, University of Texas. In 2012, Pat relocated to Children’s Hospital of
Wisconsin, Medical College of Wisconsin in Milwaukee, with plans to be more involved in translational research. During the her six years
in Milwaukee, Pat joined forces with Kelleigh’s Cause to carry out some basic research. The organization ultimately funded a Pediatric
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Radiology based postdoctoral fellowship in vascular anomalies research under the direction of Dr. Ramani Ramchandran, head of
developmental vascular biology. This program resulted in new observations of the role of endothelial cilia in vasculogenesis which were
recently published, as well as a zebrafish model for AVM being used for drug screening. Pat retired on August 31, 2018 and has relocated
to St. Petersburg, Florida. Upon retirement, Pat received Congressional tribute for all her contributions in advancement and discovery of
new knowledge in the field of vascular malformations from the 8th Congressional district of Michigan. Besides numerous visiting
professorships and keynote addresses which she cherishes, Pat is most proud of her many key publications in vascular anomalies and also
of her namesake for the chair in Pediatric Interventional Radiology and Vascular Anomalies at Children’s Hospital Boston.
She enjoys spending her time with her spouse, Jay, sharing their passion for sailing. When she is on land, she enjoys gardening and has
become an excellent potter in the past 7 years! From handling and steering that tracker catheter anywhere in all large and small vessels
from head to toe, Pat is bringing her concentration and dexterity to pottery and may all potters beware!!!
Taylor Chung, MD
Joséee Dubois, MD
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S34
SPR 2019 HONORARY MEMBER
The Society extends Honorary Membership to individuals outside of the SPR who have made outstanding contributions to the care of
children.
Omolola (Monica) Atalabi, MD
“I had a destiny to fulfill”
Dr. Omolola Mojisoloa Atalabi (Monica) is one of only a few pediatric radiologists practicing in Africa. Her remarkable story begins in
Nigeria where she was born and raised. Through sheer will and the support of family and mentors, she has become a strong advocate and
leader shining a light on the vast imaging needs of the children she serves.
The eldest of a family of six children, Monica’s father, David Daramola, was a typist in a hospital in Akure, Nigeria while her mother,
Agnes, despite no formal education, encouraged her daughter to complete school. Being the eldest, Monica was initially sent to her paternal
grandmother to be raised. There she was happily doted on, but was also told by her grandmother that she must study hard. Unbeknown to
Monica, years prior, her father broke his arm when growing up. Her grandmother saw his X-ray and was fascinated with the technology.
She hoped her son (Monica’s father) would one day become a pediatric radiologist. Not aware of this story until years after she already
had chosen radiology as a specialty, Monica truly believes she had a destiny to fulfill!
Her grandmother died when Monica was 7 and she returned to her parents’ home. While her father assumed she would marry and did not
need to complete high school, her mother continued to push her to continue her studies.
At 18, Monica met her soon to be husband Femi Atalabi, a physician. Unusual for that time, he supported her interest in schooling. She had
her first son at age 20 and second son at age 21. Femi was accepted to an OB GYN residency in Edinburgh and they moved to the United
Kingdom. Her mother helped support caring for her children while she went back full time to Cranley School for Girls in Edinburgh
Scotland. There she completed her physics requirements. Following the birth of her daughter, she applied to medical school and returned
to Nigeria to begin her 6 years of training at the University of Ibadan. When asked what specialty she was interested in she stated she had
a burning desire to enter radiology. She hoped to focus on breast imaging but to her dismay, there was only an opening in pediatrics. It
was then that she learned of her deceased grandmother’s fascination in pediatric radiology so her destiny was set.
Eager to be the best, she applied for an RSNA Derek Harwood Nash International Fellowship. In 2007, Dr. Atalabi was accepted to go for
three months to Boston Children’s Hospital. There she met many inspiring radiologist particularly George Taylor who took her under his
wing. She wrote several papers with Drs. Taylor and Ed Lee and returned to Nigeria motivated to focus on pediatrics and inspire others to
share her enthusiasm for this specialty.
Understanding the importance of growing radiology expertise in Nigeria, Monica became active in numerous societies including leadership
roles in the Medical Women Association of Nigeria, Association of Radiologists of West Africa, AAWR, SPR, Pediatric Oncology Society
of Nigeria, West African College of Surgeons, RSNA International Advisory Committee, and RSNA Committee for Middle East and
Africa. She developed a curriculum for pediatric radiology and serves as an examiner for the National Post Graduate Medical College of
Nigeria and West African College of Surgeons.
Dr. Atalabi helped found the Society of Pediatric Imaging in Nigeria (SPIN) and became President of the African Society of Pediatric
Imaging in 2015 with the encouragement of Savvas Andronikou. She became a member in council of the World Federation of Pediatric
Imaging in 2012 and currently serves as its President.
Dr. Atalabi is a cherished teacher and mentor, encouraging her students to travel and take every opportunity to learn. She has published
over 66 articles and 2 chapters including many of her trainees as coauthors. A wonderful role model, she teaches the importance of stretching
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S35
oneself, pushing forward against all odd s, recognizing opportunities rather than limitations. She was promoted to the post of
Professor of radiology in the Premier University of Ibadan in Nigeria in September 2018.
Monica lost her husband 20 years ago. Her mother, Agnes, remained a staunch advocate helping care for her children throughout her career,
and is deeply missed since her passing in 2014. Monica’s children Tola, Tomoye and Tutu are successfully independent with two
grandchildren thriving in the UK.
Monica has received many awards for her multiple accomplishments and inspiring work ethic. Invited to come to the SPR in San Francisco
in 2010 as a Heidi Patriquin International Fellow, she got a standing ovation for her presentation on the limited imaging resources children
face in Africa. This moving talk helped galvanize support for WFPI outreach, which was in its infancy. It is very fitting that Dr. Atalabi
will be awarded the SPR Honorary Membership in San Francisco this year for her wonderfully effective advocacy.
Dorothy I. Bulas, MD, FACR, FAAP
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S36
SPR 2019 HONORARY MEMBER
Kushaljit S. Sodhi, MD, PhD, MAMS, FICR
Professor Dr. Kushaljit Singh Sodhi is a pediatric radiologist and a leader among Indian radiologists. He is a Professor of Radiology at
the Postgraduate Institute of Medical Education and Research (PGIMER) in Chandigarh, India, which is one of Asia’s premier medical
institutions.
Dr. Sodhi received his medical degree from Government Medical College, Patiala in India in 1996, and he did his Radiology residency at
Dayanand Medical College Hospital in Ludhiana, India. He joined PGIMER following his residency as a senior resident/fellow, and was
subsequently appointed as a faculty member in 2003, and promoted to Associate Professor at the institute in 2006. Following this, in
2007, Dr. Sodhi completed a fellowship at the renowned Royal Children’s Hospital in Melbourne, Australia.
After his return to India, he started to accelerate the pace of his research and education endeavors in the field of pediatric radiology. His
prolific research output has resulted in more than 190 papers in peer-reviewed journals and 12 chapters in leading pediatric radiology
textbooks. His most prominent work is in establishing use of MRI of the lungs for pediatric patients, which was also the focus of his PhD.
He is a member of several editorial committees of Indian and international medical journals. He has received multiple national and
international awards recognizing his work including the Young Investigators Scholarship from the Asia Oceania Congress of Radiology
in 2008 and the very prestigious Heidi Patriquin Fellowship Award in 2011 from the SPR.
Dr. Sodhi has worked tirelessly to ensure safer imaging of children in the Indian subcontinent and is a staunch proponent of the Image
Gently campaign. He has furthered pediatric radiology education and research in India, the Asia Oceania region and other parts of the
world for the last decade. He helped establish a pediatric radiology fellowship in his institute, which was amongst the first in the Indian
subcontinent. More recently, he worked with the WFPI to establish a new three-month fellowship in India starting in April 2019.
His leadership and organizational skills have been carefully honed over the years organizing several radiology conferences in India and
the Asia Oceania region. Most recently, this was evident in his role as the organizing secretary of the Asian Oceanic Society of Pediatric
Radiology annual meeting in Chandigarh last year, which had an attendance of more than 750 delegates, the largest number in its history.
Dr. Sodhi currently serves as executive committee member of the World Federation of Pediatric imaging (WFPI). He is regarded as a
world leader in the campaign against pediatric tuberculosis and he recently took over as the leader of the tuberculosis group at the WFPI.
He serves as the current Treasurer for the Asian and Oceanic Society for Paediatric Radiology (AOSPR) and as the Secretary of the
Indian Society of Paediatric Radiology (ISPR).
Dr. Sodhi has lectured as an invited visiting professor at hospitals around the world including leading North American institutions like
Lurie Children’s Hospital in Chicago and the world-renowned Hospital of Sick Children in Toronto. At home, Dr. Sodhi is happily married to Dr. Shanujeet Kaur, an obstetrician, and they are blessed with a set of multi-talented teenager
twin sons, Arhanjit and Arnavjit.
We are proud to recognize Dr. Sodhi’s many academic, educational and organizational contributions to our field, his work as an
ambassador for pediatric imaging in the Asia Oceania region, and bestow him with an honorary membership of the SPR.
Sanjay P. Prabhu, MD
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S37
SPR 2019 JACK O. HALLER – THOMAS L. SLOVIS AWARD
This award is given in memory of Jack O. Haller and Thomas L. Slovis who both excelled as educators, and mentors. Their abilities and
enthusiasm stimulated many young medical students and residents to pursue pediatric radiology. This award is given to an individual who
has demonstrated evidence of outstanding ability to educate trainees (medical student, resident and fellow) who has shown sustained
substantial excellence in mentorship skills.
Mahesh M. Thapa, MD Mahesh Thapa attended the University of Las Vegas as an undergraduate, earning a degree in Biological Chemistry. He then obtained his M.D. at
the Keck School of Medicine at USC in Los Angeles.
After a year of internship in Las Vegas, he began a Diagnostic Radiology Residency at the University of Washington in 2000. This was followed
by a Fellowship in Pediatric Radiology at Seattle Children’s Hospital, then led by Eric Effmann. He was heavily influenced by the faculty, especially
David Brewer and Ed Weinberger, and opted to join the group in 2006.
Once on faculty, Mahesh quickly established himself as an enthusiastic creative medical educator. He took part in the University of Washington
Teaching Scholar program in 2008. Over five years, Mahesh acted as the chair of the first year Medical Student Radiology/Anatomy Correlation
course at the University of Washington, working with John Clark, the Chair of the Department of Biological Structure, providing classroom
instruction to first year medical students using software such as Osirix, Keynote, PowerPoint, and QuickTime. He enlisted many of the younger
pediatric radiology faculty in this effort, and the course was extremely well received by the medical students while simultaneously introducing the
discipline of pediatric radiology to entire medical student classes at the earliest stages of their careers.
The ability to blend a wide variety of technologic advances into educational innovation has always been a hallmark of Dr. Thapa’s success. Early
on, he developed an obsession with digital photography as a hobby, with his Instagram skills competing with and complementing his abilities as a
radiology educator, (@starvingphotographer; 270,000 followers). He continues to provide invited talks at the RSNA, AUR, and SPR on the effective
use of technology in education. In 2008, he helped to develop a PowerPoint plug-in to facilitate image stack scrolling and demonstrated how to use
common tools such as PhotoShop and Podcasting in the pursuit of greater educational impact. He also initiated a monthly SPR multi-site conference
along with Carl Merrow at Cincinnati Children’s Hospital; focused on pediatric musculoskeletal imaging, providing subspecialists worldwide an
opportunity to consult on challenging cases and learn from their peers (https://www.pedrad.org/Specialties/MSK/Multi-site-Pediatric-MSK-
Conference).
Mahesh has extended his influence by serving as an active visiting faculty in California, New York, Ohio, Georgia, and Massachusetts, also
travelling internationally to Mexico, Australia, and Canada to speak on pediatric musculoskeletal techniques and educational technology. At times,
this includes hands-on workshops in ultrasound-guided musculoskeletal procedures. His easy confidence and positive attitude are highly infectious
and lends to his great success and popularity as an instructor.
He thrives on mentoring his colleagues, including our junior faculty, all while working with clinical colleagues on challenging cases and research
projects. For many years, he has served our department as a member of the Faculty-Residency Mentorship Committee and for several years as the
Program Director for our Pediatric Radiology Fellowship.
Over his career, he has authored 48 peer-reviewed publications, served as co-editor for several books, and given 65 invited educational and scientific
talks. Mahesh is a reviewer for multiple journals - Pediatric Radiology, Radiology Case Reports, the American Journal of Roentgenology, and
serves on the Editorial Board and as Deputy Editor for Academic Radiology.
Dr. Thapa has been a member of the ABR, authoring questions for graduating trainees and CAQ certification. Nationally, he has served on the
RSNA and SPR Education Committees, the SPR Website and Musculoskeletal Committees, and over the past decade he has been very active in the
Alliance of Clinician-Educators in Radiology (ACER), serving as president in 2014-2015, and receiving the ACER Achievement Award in 2017.
Mahesh also recently served as a Co-Director for the Postgraduate Courses during the 2018 Society for Pediatric Radiology Annual Meeting. He
frequently serves as a Committee Co-Chair for the University of Washington’s Annual Emergency Radiology Course and will also be part of the
Organizing Committee for the Sunrise Sessions for IPR 2020 in Rome.
The Jack O. Haller Award is a tremendous honor that appropriately acknowledges Dr. Thapa’s unmatched enthusiasm, creativity, and genuine
interest in fostering the next generation of pediatric radiologists.
Randolph K. Otto, MD
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S38
HEIDI PATRIQUIN AWARD
In recognition of Dr. Patriquin's commitment to international education, this fellowship is designed to subsidize the expenses of one
Pediatric Radiologist per year who practices outside of North America.
Fathia Omer Salah, MD
Black Lion Hospital, Addis Ababa, Ethiopia
HEIDI PATRIQUIN AWARD
Sundar Suwal, MD
University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S39
JOHN P. CAFFEY AWARDS
John P. Caffey, MD, 1895–1978
Dr. John P. Caffey was regarded throughout the world as the father of pediatric radiology. His classic textbook, “Pediatric X-Ray Diagnosis”,
which was first published in 1945, has become the recognized bible and authority in its field. The seventh edition of this book was completed
several months before his death in 1978. It has been among the most successful books of its kind in the medical field.
Dr. Caffey was born in Castle Gate, Utah on March 30, 1895. It is interesting that he was born in the same year that Roentgen discovered
the x-ray. Dr. Caffey was graduated from University of Michigan Medical School in 1919, following which he served an internship in internal
medicine at Barnes Hospital in St. Louis. He spent three years in Eastern Europe with the American Red Cross and the American Relief
Administration, and returned to the United States for additional training in medicine and in pediatrics at the Universities of Michigan and
Columbia, respectively.
While in the private practice of pediatrics in New York City at the old Babies Hospital of Columbia University College of Physicians and
Surgeons, he become interested in radiology and was charged with developing a department of pediatric radiology in 1929. He frequently
expressed appreciation and admiration for Ross Golden, Chairman of Radiology at Columbia Presbyterian Hospital, who allowed him to
develop a separate department of diagnostic radiology without undue interference, and who was always available to help and advise him.
Dr. Caffey’s keen intelligence and inquiring mind quickly established him as the leader in the fields of pediatric x-ray diagnosis, which
recognition became worldwide almost instantaneously with the publication of his book in 1945.
Dr. Caffey received many awards in recognition of his achievements. Outstanding among these were the Mackenzie Davidson Medical of
the British Institute of Radiology in 1956, the Distinguished Service Award of the Columbia Presbyterian Medical Center in 1962, the
Outstanding Achievement Award of the University of Michigan in 1965, the Howland Award of the American Pediatric Society in 1967, the
Jacobi Award of the American Medical Association in 1972, and the Gold Medal Award of the American College of Radiology in 1975. He
had been a member of the American Journal of Roentgenology. He was a counselor of The Society for Pediatric Radiology and was an
honorary member of the European Society of Paediatric Radiology.
Dr. Caffey’s contributions to the pediatric radiologic literature were many. He was instrumental in directing attention to the fact that a
prominent thymic shadow was a sign of good health and not of disease, an observation that literally spelled the end to the practice of thymic
irradiation in infancy. Infantile cortical hyperostosis was described by him and is called “Caffey’s Disease”. Dr. Caffey in 1946 first
recognized the telltale radiographic changes that characterize the battered child, and his students helped disseminate his teachings about these
findings. It was Dr. Caffey who first recognized and descried the characteristic bony changes in vitamin A poisoning. He recognized and
described the findings associated with prenatal bowing of the skeleton.
In 1963, 3 years after his retirement from Babies Hospital, he joined the staff of the Children’s Hospital of Pittsburgh as associate radiologist
and as Visiting Professor of Radiology and Pediatrics at the University of Pittsburgh School of Medicine. Although Dr. Caffey came to
Children’s Hospital and the University of Pittsburgh in an emeritus position, he worked daily and on weekends throughout the years he was
there. In Pittsburgh, he made four major new contributions to the medical literature. He described the entity, “idiopathic familial
hyperphosphatasemia”. He recognized and described the earliest radiological changes in Perthes’ Disease. He called attention to the
potentially serious effects of shaking children, and used this as a subject of his Jacobi Award lecture. He described, with the late Dr. Kenny,
a hitherto unrecognized form of dwarfism, which is now known as the Caffey-Kenny dwarf. The John Caffey Society, which includes as its
members pediatric radiologists who have been intimately associated with Dr. Caffey, or who have been trained by his students, was
established in 1961. This society is now among the most prestigious in the field of radiology. His book and the society named in his honor
will live on as important memorials to this great man.
His greatness was obvious to all who worked with him. He was warm, kind, stimulating, argumentative, and above all, honest in his approach
to medicine and to x-ray diagnoses. His dedication to the truth was expressed in his abiding interest in the limitations of x-ray signs in
pediatric diagnosis and in his interest in normal variation in the growing skeleton. He was concerned with the written and spoken word and
was a skilled semanticist. His book and his articles are masterpieces of language and construction. He stimulated and was stimulated and
loved by all who had the privilege of working with him. Radiology and Pediatrics have lost a great man, but they shall ever have been
enriched by his presence.
Bertram R. Girdany, MD
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S40
JOHN P. CAFFEY AWARD PAPERS (1969-1998)
1969- Pneumonia of Atypical Measles: Residual Nodular Lesions; Young LW, Smith DI, Glasgow LA.
1970- Plain Skull Roentgenograms in Children with Head Trauma; Roberts F, Shopfner CE.
1971- Vascular Thromboembolism Complicating Umbilical Artery Catheterization; Williams HJ, Jarvis CW, Neal WA, Reynolds JW.
1972- Hydrometrocolpos in Infancy; Reed MH, Griscom NT.
1973- Various Radionuclide Patterns of Cerebral Inflammation in Infants and Children; Gilday DL.
1974- The Tethered Filum; Fitz CR, Harwood-Nash DC.
1975- B-Mode Ultrasound and the Nonvisualizing Kidney in Pediatrics; Shkolnik A.
1976- The Pediatric Tracheostomy: Roentgen Signs of Normal Healing and Complications-The Value of Xerography; Scott JR, Kramer
SS.
1977- A Prospective Study of Intraventricular Hemorrhage in Premature Newborns Using Computed Tomography; Burstein J, Papile L,
Burstein R.
1978- Chemotherapy-Induced Inhibition of Compensatory Renal Growth in the Immature Mouse; Moskowitz PS, Donaldson SS.
1979- Lithiasis Due to Interruption of the Enterohepatic Circulation of Bile Salts; Kirks DR.
1980- Cranial Ultrasound Findings in Patients with Meningomyelocele; Babcock DS, Han BK.
1981- Effect of Contrast Agents in the Lungs of Animals; McAlister WH, Siegel MJ, Shackelford GD, Glasier CH, Askin FB.
1982- Real-Time Ultrasonographic Detection of Vesicoureteral Reflux in Children; Kessler RM, Altman DH.
1983- Ultrasonic Evaluation of Caudal Spine Anomalies in Children; Naidich TP, Fernbach SK, McLone DG, Shkolnik A.
1984- Experimental Neonatal Intraventricular Hemorrhage: Clinical Radiographic and Pathologic Features; Goske MJ, Morin FC, Eskin
TA.
1985- The Metaphyseal Lesion in Abused Infants: A Radiologic? Histopathologic Study; Kleinman PK, Marks SC, Blackbourne BD.
1986- Magnetic Resonance Appearance of Blood and Blood Products; Cohen MD, Smith JA, Cory DA.
1987- Intussusception Reduction by Rectal Insufflation of Air; Gu L, Alton DJ, Daneman A, Stringer DA, Liu P, Wilmot DM, Reilly BJ.
1988- MR Imaging Determination of the Location of the Conus Medullaris in Normal Children and in Children with Tethered Cord
Syndrome; Wilson DA, Prince JR.
1989- Early Avascular Necrosis: MRI and Histological Examination in an Animal Model; Brody AS, Strong M, Babikian G, Seidel FG,
Kuhn JP.
1990- Determination of Functional Residual Capacity from Digital Radiography in an Animal Model of the Neonatal Chest; White KS,
Muelenaer AA, Beam CA, Effmann EL.
1991- Juvenile Colonic Perforation: Experimental Results and Clinical Applications; Shiels II WE, Keller GL, Ryckman FR, Daugherty
CC, Specker BL, Kirks DR, Summa DW.
1992- Pulmonary oxygen toxicity: Experimental assessment of capillary leakiness using contrast-enhanced MRI; Brasch RC, Berthezene
Y, Vexler V, Shames DM, Jerome H, Clément O, Mühler AR, Kuwatsuru R.
1993- High Resolution CT Assessment of Bronchoconstriction: Differential Effects of Methacholine and Histamine; Kramer SS,
Hoffman EA, Amirav I.
1994- Inhibition of Neutrophil Phagocytosis by Barium Sulfate; Hernanz-Schulman M, Hakim RM, Schulman G, Vanholder R.
1995- Evaluation of Perfusion of the Normal and Ischemic Cartilaginous Epiphysis by Using Gadolinium-enhanced MR Imaging;
Jaramillo D, Shapiro F, Villegas OL, Mulkern RV, Doty D, Dwek J.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S41
1996- The Detection of Pulmonary Metastases with Pathological Correlation: Effect of Breathing on the Accuracy of Spiral CT. Coakley
FV, Cohen MD, Waters D, Davis MM.
1997- MR Imaging Microvessel Permeability Correlates with Pathologic Tumor Grade; Brasch RC, Daldrup HE, Shames DM, Rosenau
W, Okuhata Y, Wendland, MF.
1998- Imaging Acute Heart and Lung Transplant Rejection in Rats by Using Tc-99m -radiolabeled Annexin V; Blankenberg FG, Vriens,
P, Robbins RC, Ohtusuki K, Tait JF, Strauss HW.
JOHN P. CAFFEY AWARD FOR BEST BASIC SCIENCE RESEARCH PAPER
1999- Changes in Renal Blood Flow Depicted with Contrast-enhanced Harmonic Imaging During Acute Urinary Obstruction; Claudon,
M, Barnewolt, CE, Taylor, GA, Dunning, PS, Gobet, R, MD; Badawy, A.
2000- Detection of Early Atherosclerosis with Radiolabeled Monocyte Chemoattractant Protein-1 in Prediabetic Zucker Rats;
Blankenberg FG, Tait, JF, Strauss, HW, Valentine HA.
2001- Computer-Simulated Radiation Dose Reduction For Pediatric Abdominal Helical CT, Frush, D, Slack,CC, Hollingsworth, CL,
Bisset III,GS, Donnelly, LF, Hsieh,Jl
2002- Understanding the Functional Angiogenic Process in an Antigen-Induced Arthritis Model: Correlative BOLD MR Imaging (fMRI)
of the Stages of Synovitis along the Time Course of the Disease; A. S. Doria, MD , Diagnostic Imaging, Hospital for Sick
Children, Ontario, P.S. Babyn, MD, A. Crawley, PhD, M. Noseworthy, PhD, K. Pritzker, MD, R. B. Salter, MD, et al
2003- A Novel Method for Non-Viral Gene-Therapy: Transcatheter Hydrodynamic Delivery Using Isolated Liver as a Depot Organ In a
Rabbit Model; Kevin Baskin, MD, Children’s Hospital of Philadelphia, PA, Simon J. Eastman, PhD; Ronald K. Scheule, PhD;
Bradley L. Hodges, PhD; Qiuming Chu, MS; Richard B. Towbin, MD
2004- Site-Specific Induction of Lymphatic Malformations in a Rat Model for Image-Guided Therapy; Robert F. Short, MS, Department
of Radiology, Children's Radiological Institute, Children's Hospital, Columbus, OH; William E. Shiels, DO; Thomas J. Sferra,
MD; Katherine Nicol, MD; Minka Schofield, MD; Gregory Wiet, MD
2005- Quantitative Measurement of Microbubble Ultrasound Contrast Agent Flow To Assess the Efficacy of Angiogenesis Inhibitors In
Vivo; Beth McCarville, MD, Dept of Rad Sciences, St. Jude Children’s Research Hosp, Memphis, TN; Christian Streck, MD;
Chin-Shang Li, PhD; Andrew Davidoff, MD
2006- 4Cu-Immuno-PET Imaging of Neuroblastoma with Bioengineered Anti-GD2 Antibodies; Stephan D Voss, MD, PhD, Radiology,
Children’s Hospital Boston, Harvard Medical School, Boston, MA; Suzanne V Smith, PhD; Nadine M Di Bartolo, PhD; Lacey J
McIntosh; Erika M Cyr; Ali A Bonab, PhD, et. al.
2007- MR Imaging of Adenocarcinomas with Folate-Receptor Targeted Contrast Agents; Heike E Daldrup-Link, MD, PhD, Radiology,
University of California San Francisco, San Francisco, CA; Zhen J Wang, MD; Reinhard Meier, MD; Claire Corot, PhD
2008- Evaluation of Quality Assurance Quality Control Phantom for Digital Neonatal Chest Projection Imaging; Steven Don, MD,
Mallinckrodt Institute of Radiology, Washington University School of Medicine
2009- Faster Pediatric MRI Via Compressed Sensing - Shreyas Vasanawala, Stanford University, Marcus Alley, Richard Barth, Brian
Hargreaves, John Pauly, Michael Lustig
2010- Clinical Evaluation of Readout-Segmented-EPI for Diffusion-Weighted Imaging – Roland Bammer, PhD, Stanford University,
Palo Alto, CA, Samantha J Holdsworth, PhD;Stefan Skare, PhD; Kristen Yeom, MD; Patrick D Barnes, MD
2010- High-Resolution Motion-Corrected Diffusion-Tensor Imaging (DTI) in Infants – Stefan T Skare, PhD, Stanford University,
Stanford, CA; Samantha J Holdsworth, PhD; Kirsten Yeom, MD; Patrick D Barnes, MD; Roland Bammer, PhD
2010- 3D SAP-EPI in Motion-Corrected Fast Susceptibility Weighted Imaging (SWI) – Roland Bammer, PhD, Stanford University, Palo
Alto, CA, Samantha J Holdsworth, PhD; Stefan Skare, PhD; Kristen Yeom, MD; Patrick D Barnes, MD
2010- T1-Weighted 3D SAP-EPI for Use in Pediatric Imaging – Roland Bammer, PhD, Stanford University, Palo Alto, CA, Samantha J
Holdsworth, PhD; Stefan Skare, PhD; Kristen Yeom, MD; Patrick D Barnes, MD
2011- An MR System for Imaging Neonates in the NICU, Jean Tkach, Randy Giaquinto, Wolfgang Loew, Ronald Pratt, Barret Daniels,
Blaise Jones, Lane Donnelly, Charles Dumoulin, Cincinnati Children's Hospital Medical Center
2012- Advantages of a Nanoparticle Blood Pool Contrast Agent Over Conventional Intravascular Glomerular-Filtered Contrast Agents
for Pulmonary Vascular Imaging; Ananth Annapragada, Texas Children's Hospital, R. Paul Guillerman, Eric Hoffman, David
Kaczka, Ketan Ghaghada, Cristian Badea
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S42
2013- Psychometric Function: A Novel Statistical Analysis Approach to Optimize CT Dose: Steven Don, MD, Mallinckrodt Institute of
Radiology, St. Louis, MO,Bruce Whiting, David Politte, Parinaz Massoumzadeh, Charles Hildebolt
2014- No longer a holiday: Improving the pediatric radiology elective for medical students and pediatric housestaff Eddie Hyatt,
Vanderbilt University, Department of Radiology and Radiological Sciences, Nashville, TN, Cody Penrod, Sudha Singh, Jayne
Seekins, DO, Amy Fleming, Melissa Hilmes, MD
2015- Gonad Shields: Good or Bad for Patient Radiation Exposure?; Summer L. Kaplan, MD, Department of Radiology, The Children's
Hospital of Philadelphia, Philadelphia, PA, Dennise Magill, MS, Marc A. Felice, MS, Sayed Ali, MD, Xiaowei Zhu, MS
2016- In vivo Profiling of Folate Receptor Expression in Rat Placenta Using MR Molecular Imaging; Ketan Ghaghada, PhD, Zbigniew
Starosolski, PhD, Eric Tanifum, PhD, Haijun Gao, PhD, Igor Stupin, MD, PhD, Saakshi Bhayana, BS, Chandresh Patel, BS,
Chandrasekhar Yallampalli, DVM, PhD, Ananth Annapragada, PhD, Texas Children’s Hospital, Houston, TX
2017- Performance of a Deep Neural Network Learning Model in Assessing Skeletal Maturity on Pediatric Hand Radiographs; David B.
Larson, MD, MBA, Matthew C. Chen, Matthew P. Lungren, MD, MPH, Safwan S. Halabi, MD, Nicholas V. Stence, MD, Curtis
P. Langlotz, MD, PhD Radiology, Stanford University, Stanford, CA University of Colorado, Aurora, CO
2018- Feed and Wrap MRU; Sila Kurugol, PhD, Radiology, Boston Children’s Hospital and Harvard Medical School, Onur Afacan, PhD,
Catherine Seager, MD, Reid Nichols, Richard S. Lee, MD, Simon K. Warfield, PhD, Jeanne S. Chow, MD
JOHN P. CAFFEY AWARD FOR BEST CLINICAL RESEARCH OR EDUCATION PAPER
1999 - Triangular Cord Sign in Biliary Atresia: A Gold Standard for the Millennium? Tan Kendrick AP, Phua, KB, Subramaniam, R.
2000 - Cisterna Magna Thrombus and Subsequent Posthemorrhageic Hydrocephalus. Cramer BC, Walsh EA.
2001 - Aneurysmal Bone Cysts In Children: Percutaneous Sclerosing Therapy, An Alternative To Surgery. Dubois J, Garel LA, Rypens
FF, Grimard G, Isler, M, Mercier C
2002 - MR Imaging of Kidneys: Functional Evaluation Using F-15 Perfusion Imaging, Grattan-Smith D, Jones RA; Little S, Perez M,
Kirsch A
2003 - Differential Regurgitation in Branch Pulmonary Arteries after TOF Repair. Yoo SJ, Kang IS, Redington A, Benson LN;
Macgowan CK; Valsangiacomo ER
2004 - Feasibility of a Free-Breathing SSFP Sequence for Dymanic Cardiac Imaging in Pediatric Patients. Krishnamurthy, R,
Muthupillai R, Vick G, Su J, Kovalchin J, Chung T; Diagnostic Imaging, Texas Children’s Hospital, Houston, TX
2005 - Evaluation of High Resolution Cervical Spine CT In 529 Cases of Pediatric Trauma: Value Versus Radiation Exposure. Shiran, D,
Jimenez, R, Altman, D, DuBose, M, Lorenzo, R
2006 - Alterations in Regional O2 Saturation (StO2) and Capillary Blood Volume (HbT) with Brain Injuries and ECMO. P Ellen Grant,
MD, Pediatric Radiology, Massachusetts General Hospital, Boston, MA; George Themelis; Kara Arvin, MD; Sonal Thaker;
Kalpathy K Krishnamoorthy, MD; Maria Angela Franceschini, PhD
2007 - Evaluation of Single Functioning Kidneys Using MR Urography. Damien Grattan-Smith, MBBS, Department of Radiology,
Children’s Healthcare of Atlanta, Atlanta, GA; Richard Jones, PhD; Stephen Little, MD; Andrew Kirsch, MD; Adina Alazraki,
MD
2008 - Evaluating the Effects of Childhood Lead Exposure with Proton MR Spectroscopy & Diffusion Tensor Imaging Neuroradiology;
Kim M Cecil PhD, Cincinnati Children's Hospital Medical Center
2009 - Improving Patient Safety: Effects of a Safety Program on Performance and Culture in a Department of Radiology at a Children's
Hospital - Lane Donnelly, Cincinnati Children's Hospital Medical Center, Julie Dickerson, Martha Goodfriend, Stephen Muething
2010 - Juvenile Osteochondritis Dissecans (JOCD): Is It a Growth Disturbance of the Secondary Physis of the Epiphysis? Tal Laor, MD,
Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, Eric J Wall, MD; Andrew M Zbojniewicz, MD
2011 - Quantitative Assessment of Blood Flow with 4D Phase-Contrast MRI and Autocalibrating Parallel Imaging Compressed Sensing,
Albert Hsiao, Stanford University, Micheal Lustig, Marcus Alley, Mark Murphy, Shreyas Vasanawala
2012 - Multidetector CT Pulmonary Angiography in Children with Suspected Pulmonary Embolism: Thromboembolic Risk Factors and
Implications for Appropriate Use; Edward Lee, MD, MPH, Children's Hospital, Boston, Sunny K. Tse, David Zurakowski , Victor
M. Johnson, Tracy A. Donald, Phillip M. Boiselle
2013 - Prospective Comparison of MRI and Ultrasound for the Diagnosis of Pediatric Appendicitis; Robert Orth, MD, PhD, Texas
Children’s Hospital, Houston, TX, R. Paul Guillerman, Prakash Masand, MD, Wei Zhang, George Bisset
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S43
2014 - Ultrasound-Derived Shear Wave Speed Correlates with Liver Fibrosis in Children; Jonathan Dillman, M.D., Department of
Radiology, Section of Pediatric Radiology, University of Michigan C.S. Mott Children’s Hospital, Ann Arbor, MI, Ethan Smith,
Amer Heider, Nahid Keshavarzi, Jacob Bilhartz, Jonathan Rubin
2015 - Contrast Enhanced Ultrasound in the Assessment of Pediatric Solid Tumor Response to Anti-Angiogenic Therapy; Beth
McCarville, MD, Department of Radiological Sciences, Division of Diagnostic Imaging, St. Jude Children's Research Hospital,
Memphis, TN, Jamie Coleman, MD, Junyu Guo, PhD, Yimei Li, PhD, Xingyu Li, PhD, Fariba Navid, MD
2016- Intra-operative MRI guided, laparoscopic-assisted anorectoplasty in the treatment for imperforate anus; Damien Grattan-Smith,
MBBS, Children’s Healthcare of Atlanta, Atlanta, GA, George Raschbaum, John Bleacher, Joseph Williams, Edwin Smith,
Stephen Little, Richard Jones
2017- CXR Reduction Protocol in the Neonatal Intensive Care Unit (NICU) – Lessons Learned; Michelande Ridore, MS, Dorothy Bulas,
MD, William Pastor, MS, MPH, Sarah McKenney, PhD, Lamia Soghier, MD, Billie Lou Short, MD, CNMC, Washington DC
2018- Association of T2 Lymphatic Imaging in Single Ventricle Patients After Superior Cavopulmonary Connection with Acute Post-
Fontan Outcomes; David Biko, MD, Department of Radiology, The Children’s Hospital of Philadelphia, Aaron Dewitt, MD,
Michael O’Byrne, MD, Mark Fogel, MD, Matthew Harris, MD, Sara Partington, MD, Kevin Whitehead, MD, PhD, David Saul,
MD, David Goldberg, Jack Rychik, Andrew Glatz, MD, Matthew Gillespie, MD, Jonathan Rome, MD, Yoav Dori
JOHN P. CAFFEY AWARD FOR POSTERS
1994- Wilms Tumor: Unusual Manifestations. Navoy JF, Royal SA, Vaid YN, Mroczek EC.
1995- Evaluation of Suspected Air Trapping with Dynamic CT Densitometry. Johnson JL, Kramer SS, Mahboubi S.
1996- MR Imaging in the Diagnosis of Experimental Pyelonephritis in Piglets. Pennington, Lonergan GJ, Flack CE, Waguespack L,
Jackson CB.
1997- Sensorineural Hearing Loss in Children. Lowe LH, Vezina GL.
1998- Primary Immunodeficiencies: An Immunology Primer for Radiologists. Manson DE, Sikka BS, Cohen S, Reid B, Roifman CM.
1999- Retinoblastoma: US Findings with Pathologic Correlation Kaste, SC, Jenkins, III, JJ, Pratt, CB; Langston, JW, Haik, BG
2001- Mitochondrial Disorders Of Oxidative Phosphorylation In Children: Patterns Of Disease Palasis S, Grattan-Smith JD, Shoffner
JM, Neish AS, Stewart S.
2002- Volumetric Localization of Somatosensory Cortex in Children Using Synthetic Aperture Magnetrometry. Xiang J, MD, PhD, The
Hospital for Sick Children, Toronto, ON, Canada Chuang S., MD; Holowka S; Babyn P, Otsubo H, Sharma R
2003- Assessing the Use of Magnetic Resonance Imaging in Determining the Age of Closure of Growth Plates. Rajwani T, Huang EM,
Secretan C, Bhargava R, Lambert R, Bagnall K
2004- Outstanding Basic Science Research Poster - Imaging of the Diaphragm in Neonates and Young Infants, with Special Emphasis on
Diaphragmatic Motion. Epelman M, Navarro O, Miller S Department of Diagnostic Imaging, Hospital for Sick Children, Toronto,
ON, Canada
2004- Outstanding Clinical Research Poster - The Spectrum of Renal Cystic Disease in Children. Restrepo R, Ranson M, Sookman J,
Jacobson E, Daneman A, Fontalvo L, Department of Radiology, Miami Children's Hospital, Miami, FL
2005- 3D MRI and CT in the Evaluation of Congenital Anomalies of the Aortic Arch. Dehkharghani S, Olson K, Richardson, R
2006- Diffusion Weighted Imaging in Pediatric Neuroradiology: A Primer. Pallavi Sagar, MD, Pediatric Radiology, Massachusetts
General Hospital, Boston, MA; P Ellen Grant, MD
2006- Imaging of Suprarenal Fossa in Children: Radiological Approach and Clinico-Pathological Correlation. Kamlesh Kukreja, MD,
Radiology, Miami Children’s Hospital, Miami, FL; Ricardo Restrepo, MD; Maria D’almeida, MD
2007- Neuroimaging of Nonaccidental Trauma: Pitfalls and Controversies. Lisa H Lowe, MD, Radiology, Children’s Mercy Hospitals
and Clinics and The University of Missouri-Kansas City, Kansas City, MO; Ruby E Obaldo, MD; Kristin A Fickenscher, MD;
Irene Walsh, MD
2008- Estimation of Cumulative Effective Doses from Diagnostic and Interventional Radiological Examinations in Pediatric Oncology
Patients. KE Thomas, BA Ahmed, P Shroff, B Connolly, A Lee Chong, C Gordon, The Hospital for Sick Children – Toronto
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S44
2009- Case Report: Multi-Modality Imaging Manifestations of the Meckel’s Diverticulum in Pediatric Patients. Manish K Kotecha, MD,
Richard D Bellah, MD, Andres H Pena, MD, Peter Mattei, MD
2009- Educational: MR Urography: Functional Analysis – Made Simple! Dmitry Khrichenko, BSc, Kassa Darge, MD, PhD
2009- Scientific: MRI Findings in the Term Infant with Neonatal Seizures. An Etiologic Approach - Monica Rebollo Polo,Julie Hurteau-
Miller, Eoghan Laffan, Hazar Tabban, Husein Naser, Khaldoun Koujok
2010- Scientific: Dual Phase Intravenous Contrast Injection in Pediatric Body CT Erika Mann, MD, Hospital for Sick Children,Toronto,
ON, CA, Amin Alzahrani; Nancy Padfield; Liane Farrell; Guila BenDavid; Karen Thomas, MD
2010- Educational: Hemangiomas Revisited: The Useful, the Unusual and the New Ricardo Restrepo, MD, Miami Children’s Hospital,
Miami, FL, Rajaneeshankar Palani, MD; Umamahesh Matapathi, MD; Nolan Altman, MD; Luisa Cervantes, MD; Ana-Margarita
Duarte, MD; Ibrahim Amjad, MD
2010- Case Report: MRI of Congenital Urethroperineal Fistula Maryam Ghadimi Mahani, MD, University of Michigan Health System,
C.S. Mott Children’s Hospital, Ann Arbor, MI, Jonathan R Dillman, MD; Deepa Pai, MD; John M Park, MD; Michael A Dipietro,
MD; Maria F Ladino Torres, MD
2011- Scientific: Updated Estimated Radiation Dose for Pediatric Nuclear Medicine Studies, Frederick Grant, Children's Hospital,
Boston, Laura Drubach, S. Ted Treves, Fred Fahey
2011- Educational: Button Battery Ingestion in Children: What the Radiologist Must Know, Mariam Kappil, Children's Memorial
Hospital, Chicago, Cynthia Rigsby, Martha Saker, Emma Boylan
2011- Case Report: MR Imaging Features of Fetal Mediastinal and Intrapericardial Teratomas, Eva Rubio, Children's National Medical
Center, Washington, DC, Beth Kline-Fath, Maria Calvo-Garcia, Carolina Guimaraes
2012- Case Report: Neuroimaging in Hemiplegic Migraine: Cases and Review of the Literature, Nicholas V. Stence, Children's Hospital
Colorado, Sita Kedia, John A. Maloney, Jennifer Armstrong-Wells, Timothy Bernard
2012- Educational: Primary and Secondary Amenorrhea in Pediatric Patients: From the Beginning to the End, Cesar Cortes, Miami
Children's Hospital, Yanerys Ramos, Ricardo Restrepo, Alejandro Diaz, Lorena Sequeira, Edward Lee
2012- Scientific: Prenatal Evaluation of Limb Body Wall Complex with Emphasis on MRI, Elisa Aguirre-Pascual, Hospital Universitario
de Getafe, Teresa Victoria, Ann Johnson, Nancy Chauvin, Beverly Coleman, Monica Epelman
2013- Case Report: Percutaneous trans-splenic embolization of Roux limb varices in children with chronic portal vein occlusion (PVO)
post orthotopic liver transplant (OLT) Sheena Pimpalwar,MD, Texas Children’s Hospital- Interventional radiology, Houston, TX;
Aparna Annam, Ponraj Chinnadurai, Alberto Hernandez
2013- Educational: MR imaging of coronary arteries in children: Case Based Teaching File, Roy Jacob, MD, Children’s Medical center,
Dallas, TX; Shannon Blalock, Jeanne Dillenbeck
2013- Scientific Exhibit: Phantom Iterative Reconstruction Technique (PIRT)-a quantitative ALARA method to test iterative
reconstructions effect on image quality and dose in the pediatric population Anne McLellan, DO, Medical, Radiology, Phoenix
Children’s Hospital, Phoenix, AZ; James Owen, MS, Robyn Augustyn, BSRT (R)(CT), John Egelhoff, DO, John Curran, MD
Jeffrey Miller, MD, Richard Southard, MD William Pavlicek, PhD, Richard Towbin, MD
2013- Scientific Exhibit: Morbidity associated with delayed treatment of cholelithiasis in pediatric patients with sickle cell disease
Heather Imsande, MD, Boston Medical Center, Boston, MA
2014- Case Report: Contrast-enhanced Ultrasound of Pediatric Abdominal Visceral Trauma: Initial Data; Beatrice Dionigi, Carol
Barnewolt, Jill Zalieckas, David Mooney, Harriet Paltiel, MD, Department of Surgery, Boston Children’s Hospital, Boston, MA
2014- Educational Poster: The Pediatric Breast: What to do with Lumps and Bumps; Natalie Burns, University of Washington Medical
Center, Seattle, WA, Habib Rahbar, Teresa Chapman
2014- Scientific Poster: Towards radiation dose reduction in MDCT with iterative reconstruction for the prenatal diagnosis of skeletal
dysplasia: the minimum radiation dose required to evaluate the normal fetal bones?; Chihiro Tani, Hiroshima University Hospital,
Hiroshima, Japan, Yoshinori Funama, Chikako Fujioka, Kazuo Awai
2015- Case Report: Congenital Portocaval Shunt: A Rare Entity, Arash Zandieh, MD, Georgetown University Hospital, Washington, DC,
Christabel Lee, Frank Volberg
2015- Educational Poster: Pediatric Radiology Economics and Politics in Jeopardy: A Primer, David Swenson, MD, The Alpert Medical
School of Brown University, Providence, RI, Cassandra Sams
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S45
2015- Scientific Poster: Infant Bone Age Estimation Based on Fibular Shaft Length: A Validation Study, Andy Tsai, MD, PhD, Boston
Children's Hospital, Boston, MA, Catherine Stamoulis, Sarah Bixby, Michael Breen, Susan Connolly, Paul Kleinman
2016- Case Report: Imaging Appearances of Crayons; Aaron McAllister, MD, MS, Radiology, Cincinnati Children's Hospital,
Cincinnati, OH, Neil Lall, MD, Radiology, Cincinnati Children's Hospital, Cincinnati, OH
2016- Educational Poster: Pediatric Thyroid Cancer: Common Sonographic Appearances and Pitfalls; Claudia Martinez-Rios, MD,
Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada, Lydia Bajno, Alan Daneman, Rahim Moineddin,
Danielle CM van der Kaay, Jonathan Wasserman
2016- Scientific Poster: Ultrasound Diagnosis of Median Arcuate Ligament Syndrome (MALS): A Single Institutional Experience;
Anjum Bandarkar, Children's National Health System, Washington, DC, Hansel Otero, MD
2017- Case Report: Cutaneous Metastases of Infantile Choriocarcinoma can Mimic Infantile Hemangioma both Clinically and
Radiographically; Logan Dance, MD; Patricia Cornejo, MD; Mittun Patel, MD, Phoenix Children's Hospital, Phoenix, AZ
2017- Educational Poster: Sonographic Evaluation of Diaphragmatic Motion: A Practical Guide to Performance and Interpretation;
Benjamin D. Smith, MD, Hansel Otero, MD, Tara Cielma, Anjum Bandarkar, MD, Children’s National Medical Center,
Washington, DC
2017- Educational Poster: Nuts and Bolts: A Radiologist’s Guide to Orthopedic Hardware Utilized in the Lower Extremities of Children;
Hailey Allen, MD, Radiology University of Wisconsin, Madison, WI, Kirkland Davis, MD, Kenneth Noonan, MD, Jie Nguyen,
MD
2017- Scientific Poster: Sinusoidal Obstruction Syndrome Causes Increased Liver Stiffness; Naresh Reddivalla, MD, Erin Opfer, DO,
Amie Robinson, BSRT(R)(MR) CCRP, Kimberly J Reid, MS, Mohamed Radhi, MD, & Sherwin Chan, MD, PhD, The Children’s
Mercy Hospital, Kansas City, MO
2018- Case Report: Calcifying Nested Stromal-Epithelial tumor of the liver: Case report of a rare primary liver tumor; Deepa Biyyam,
MD, Mostafa Youssfi, MD, Gerald Mandell, MD, Steve Taylor, MHS, PA and Mittun Patel, MD
2018- Educational Poster: Optimizing Pediatric Leptomeningeal Metastasis Detection: Technical Considerations; Julie H. Harreld, MD,
Muhammad Ayaz, PhD, Claudia M. Hillenbrand, PhD; Ralf B. Loeffler, PhD, Zoltan Patay, MD, PhD
2018- Scientific Poster: 3D T1-Weighted Post-Contrast Spine and Abdomen 3 Tesla MRI Using a Golden Angle Radial Acquisition; H.
Harry Hu, PhD, Thomas Benkert, PhD, Ramkumar Krishnamurthy, PhD, Mark Smith, MS, Jerome Rusin, MD, Aaron McAllister,
MD, Jeremy Jones, MD, Brent Adler, MD, Cody Young, MD, Kathryn Milks, MD, Rajesh Krishnamurthy, MD, and Kai Tobias
Block, PhD
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S46
2019 EDWARD B. D. NEUHAUSER LECTURER
Jitendra Malik, PhD
Deep Visual Understanding from Deep Learning
Jitendra Malik received the B.Tech degree in Electrical Engineering from Indian Institute of Technology, Kanpur in 1980 and the PhD
degree in Computer Science from Stanford University in 1985. In January 1986, he joined the University of California at Berkeley, where
he is currently the Arthur J. Chick Professor in the Department of Electrical Engineering and Computer Sciences. He is also on the faculty
of the department of Bioengineering, and the Cognitive Science and Vision Science groups. During 2002-2004, he served as the Chair of
the Computer Science Division and as the Department Chair of EECS during 2004-2006 as well as 2016-2017. Since January 2018, he is
also Research Director and Site Lead of Facebook AI Research in Menlo Park.
Prof. Malik's research group has worked on many different topics in computer vision, computational modeling of human vision, computer
graphics and the analysis of biological images. Several well-known concepts and algorithms arose in this research, such as anisotropic
diffusion, normalized cuts, high dynamic range imaging, shape contexts and R-CNN. He has mentored more than 60 PhD students and
postdoctoral fellows. His publications have received numerous best paper awards, including five test of time awards - the Longuet-Higgins
Prize for papers published at CVPR (twice) and the Helmholtz Prize for papers published at ICCV (three times). He received the 2013
IEEE PAMI-TC Distinguished Researcher in Computer Vision Award, the 2014 K.S. Fu Prize from the International Association of Pattern
Recognition, the 2016 ACM-AAAI Allen Newell Award, and the 2018 IJCAI Award for Research Excellence in AI. He is a fellow of the
IEEE and the ACM. He is a member of the National Academy of Engineering and the National Academy of Sciences, and a fellow of the
American Academy of Arts and Sciences.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S47
2019 SOCIAL EVENTS
SPR RESEARCH AND EDUCATION FOUNDATION FUN RUN
Wednesday, May 1, 2019
6:00 a.m. – 7:45 a.m.
Join us for a three-mile run through Downtown San Francisco and get your day off to a great start!
Runners and walkers are all welcome. Entrance fee is $25 and includes a T-shirt.
Runners/walkers should meet in the Hotel lobby at 5:45 a.m.
Underwritten by Texas Children’s Hospital
EXHIBIT HALL KICK-OFF PARTY
Wednesday, May 1, 2019
3:30 p.m. – 4:00 p.m.
Hilton San Francisco Union Square, Golden Gate Ballroom
Join us as we welcome the 2019 SPR Exhibitors.
WELCOME RECEPTION
Wednesday, May 1, 2019 7:00 p.m. - 8:00 p.m. Hilton San Francisco Union Square, Plaza Room
Hors d’oeuvres and Refreshments will be served. Business Casual Attire
RECEPTION AND ANNUAL BANQUET
Friday, May 3, 2019 7:00 p.m.-10:30 p.m.
Hilton San Francisco Union Square, Vista Room
Reception, Dinner and Dancing. Business Casual Attire.
Registration fees apply.
SPR XCHANGE LOUNGE
Come kick back and relax at the SPR XChange Networking Lounge!
Hilton San Francisco Union Square, Golden Gate Ballroom
The lounge will be open throughout the meeting during Exhibit Hall hours.
SAN FRANCISCO ACTIVITIES
The Hilton San Francisco Union Square employs concierge staff who are happy to share their detailed knowledge of San Francisco,
California and the surrounding area. You may contact them by email at [email protected].
Additional information is included on the SPR website.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S48
2019 SCHEDULE OF EVENTS
POSTGRADUATE COURSE PROGRAM
TUESDAY, APRIL 30
7:00 AM – 8:00 AM Continental Breakfast – East Lounge
7:00 AM – 5:00 PM Registration – East Lounge
7:00 AM – 5:00 PM ePoster Viewing – East Lounge
8:00 AM – 11:59 PM Cases of the Day Online Activity
8:00 AM – 10:00 AM Postgraduate Course Track I (SAM) – Newborn and Young Infant
Continental Ballroom 4&5
8:00-8:20 a.m. Welcome & Introduction
Janet R. Reid, MD, FRCPC & Taylor Chung, MD, SPR President
8:20-8:30 a.m. NEC Ultrasound/X-ray – How To
Janet R. Reid MD, FRCPC
8:30-8:40 a.m. NEC – Complicated Cases
Nadia F. Mahmood, MD
8:40-8:50 a.m. Newborn Bowel Obstruction – How To
D. Gregory Bates, MD
8:50-9:00 a.m. Newborn Bowel Obstruction – Cases
Boaz Karmayzn, MD
9:00-9:10 a.m. UTD Classification System – Pros and Cons
Jeanne “Mei-Mei” S. Chow, MD
9:10-9:20 a.m. UTD Cases on MRI and US
Andrew T. Trout, MD
9:20-9:30 a.m. Radiologic Approach: Neonate with Disorder of Gender Development
Heather Bray, MD
9:30-9:40 a.m. Challenging Cases of Infant Lung Disease
R. Paul Guillerman, MD
9:40-10:00 a.m. Discussion
8:00 AM – 10:00 AM Postgraduate Course Track II (SAM) – Body Non-Trauma
Continental Ballroom 6
8:00-8:20 a.m. Welcome & Introduction
S. Pinar Karakas, MD & Taylor Chung, MD, SPR President
8:20-8:30 a.m. Radiologic Approach: Scrotal Pain with Positive Flow
S. Pinar Karakas, MD
8:30-8:40 a.m. MRI in Acute Abdomen – How To
Jesse Courtier, MD
8:40-8:50 a.m. MRI in Acute Abdomen – Cases (Adnexal/Mullerian/Other)
Unni K. Udayasankar, MD
8:50-9:00 a.m. Intussusception – How To
Sudha A. Anupindi, MD
9:00-9:10 a.m. Intussusception – Complicated Cases
Oscar M. Navarro, MD
9:10-9:20 a.m. Child with Chest Pain - Cases
David Saul, MD
9:20-9:30 a.m. Child with Stridor - Cases
Evan J. Zucker, MD
9:30-9:40 a.m. Challenging X-rays – Cases from the Emergency Room
James E. Crowe, MD
9:40-10:00 a.m. Discussion
10:00 AM – 10:20 AM Break
10:20 AM – 12:00 PM Postgraduate Course Track I (SAM) – Body
Continental Ballroom 4&5
10:20-10:30 a.m. Diffuse Liver Disease – How To (US & MRI Elastography)
Jonathan R. Dillman, MD, MSc
10:30-10:40 a.m. Diffuse Liver Disease - Cases
Prakash M. Masand, MD
10:40-10:50 a.m. Crohn’s Disease Standardized Nomenclature/Reporting – How To
Michael S. Gee, MD, PhD
10:50-11:00 a.m. Crohn’s Disease Standardized Nomenclature/Reporting – Cases
Ethan A. Smith, MD
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S49
11:00-11:10 a.m. Esophageal Disease – How To
Steven J. Kraus, MD, MS
11:10-11:20 a.m. Esophageal Disease – Cases
Lynn A. Fordham, MD, FACR
11:20-11:30 a.m. Radiologic Approach: Teenager with Amenorrhea
Laura Z. Fenton, MD, FACR
11:30-11:40 a.m. Challenging Cases of Pancreatitis
Michael J. Callahan, MD
11:40 a.m.-12:00 p.m. Discussion
10:20 AM – 12:00 PM Postgraduate Course Track II (SAM) – Body Trauma
Continental Ballroom 6
10:20-10:30 a.m. Pros and Cons of American Association for the Surgery of Trauma (AAST) Classifications
Christopher Newton, MD
10:30-10:40 a.m. Chest Trauma: Lung and Diaphragm
Paul G. Thacker, MD, MHA
10:40-10:50 a.m. Abdomen Trauma: Liver, Spleen and Pancreas
Michael Aquino, MD
10:50-11:00 a.m. Abdomen Trauma: Bowel and Mesentery
Ramesh S. Iyer, MD
11:00-11:10 a.m. Abdomen Trauma: Renal, Ureter and Bladder
Henry J. Baskin, MD
11:10-11:20 a.m. Abdomen Trauma: Shock Abdomen
Emily S. Orscheln, MD
11:20-11:30 a.m. Radiologic Approach: Child with Straddle Injury (Perineal, Urethral, Scrotal Injury)
Summer L. Kaplan, MD, MS
11:30-11:40 a.m. Challenging Cases of Ingested, Aspirated and Penetrated Foreign Bodies
Beverly Newman, MD, FACR
11:40 a.m.-12:00 p.m. Discussion
12:00 PM – 1:30 PM Lunch on Own
12:00 PM – 1:30 PM jSPR Luncheon (pre-registration required)
Continental Ballroom 2&3
Panel Presentation: Mentorship: Sharing Mentees and Mentors Experiences
1:30 PM – 3:00 PM Postgraduate Course Track I (SAM) – Oncology
Continental Ballroom 4&5
1:30-1:40 p.m. Neuroblastoma Imaging Update on IDRF - How To
M. Beth McCarville, MD
1:40-1:50 p.m. Neuroblastoma Imaging Update on IDRF - Cases
Meryle Eklund, MD
1:50-2:00 p.m. Imaging of Liver Masses – How to (Including PRETEXT)
Alexander J. Towbin, MD
2:00-2:10 p.m. Imaging of Liver Masses - Cases
Ellen M. Chung, MD
2:00-2:10 p.m. Lymphoma/Leukemia – How To
Lisa J. States, MD
2:10-2:20 p.m. Lymphoma/Leukemia - Cases
Stephan D. Voss, MD, PhD
2:20-2:30 p.m. Radiologic Approach: Post Oncologic Treatment Complications
Geetika Khanna, MD, MS
2:30-2:40 p.m. Challenging Cases of Oncologic Emergencies
Heike E. Daldrup-Link, MD, PhD
2:40-3:00 p.m. Discussion
1:30 PM – 3:00 PM Postgraduate Course Track II (SAM) – Neuro Non-Trauma
Continental Ballroom 6
1:30-1:40 p.m. Radiologic Approach: Child with Acute Lower Extremity Weakness
Korgun Koral, MD
1:40-1:50 p.m. Increased Intracranial Pressure – How To
Jason N. Wright, MD
1:50-2:00 p.m. Increased Intracranial Pressure - Cases
Jonathan G. Murnick, MD, PhD
2:00-2:10 p.m. Stroke and Look-alikes – How To
Aylin Tekes, MD
2:00-2:10 p.m. Stroke and Look-alikes - Cases
Dennis W. W. Shaw, MD
2:10-2:20 p.m. Acute Encephalopathy – How To
Manohar Shroff, MD, FRCPC
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S50
2:20-2:30 p.m. Acute Encephalopathy - Cases
Bruno P. Soares, MD
2:30-2:40 p.m. Challenging Cases of Complicated Sinusitis/Mastoiditis
Sumit Pruthi, MBBS, DNB
2:40-3:00 p.m. Discussion
3:00 PM – 3:20 PM Break
3:20 PM – 5:00 PM Postgraduate Course Track I (SAM) – MSK
Continental Ballroom 4&5
3:20-3:30 p.m. Joint Disease – How To
Sarah D. Bixby, MD
3:30-3:40 p.m. Joint Disease - Cases
Apeksha Chaturvedi, MBBS, MD
3:40-3:50 p.m. Imaging of FAI- How To
Jerry R. Dwek, MD
3:50-4:00 p.m. Imaging of FAI - Cases
Molly E. Dempsey, MD
4:00-4:10 p.m. Bone Marrow Imaging – How To
Andrew Schapiro, MD
4:10-4:20 p.m. Bone Marrow Imaging - Cases
Kirsten Ecklund, MD
4:20-4:30 p.m. Radiologic Approach: Child with Multifocal Bone Lesions
A. Carl Merrow, MD
4:30-4:40 p.m. Challenging Cases of Peripheral Neuropathy (US-MRI)
Ricardo Restreppo, MD
4:40-5:00 p.m. Discussion
3:20 PM – 5:00 PM Postgraduate Course Track II (SAM) – Neuro Trauma
Continental Ballroom 6
3:20-3:30 p.m. Challenging Cases of NAT
Gary L. Hedlund, DO
3:30-3:40 p.m. Child with Severe Head Trauma – How To
Laura L. Hayes, MD
3:40-3:50 p.m. Child with Severe Head Trauma - Cases
Hisham Dahmoush, MBBCh
3:50-4:00 p.m. C-Spine Trauma – How To
Camilo Jaimes, MD
4:00-4:10 p.m. C-Spine Trauma - Cases
Judith A. Gadde, DO, MBA
4:10-4:20 p.m. Facial and Orbital Trauma – How To
Timothy N. Booth, MD
4:20-4:30 p.m. Facial and Orbital Trauma - Cases
Asim F. Choudhri, MD
4:30-4:40 p.m. Challenging Cases of Thoracic Spine Trauma
Nicholas V. Stence, MD
4:40-5:00 p.m. Discussion
5:00 PM Adjourn
WEDNESDAY, MAY 1
6:00 AM SPR/REF Fun Run
Meet in the hotel lobby at 5:45 a.m..
7:00 AM – 8:00 AM Continental Breakfast & Exhibit Hall Opens – Golden Gate Ballroom
8:00 AM – 11:59 PM Cases of the Day Online Activity
7:00 AM – 7:45 AM Siemens Breakfast Session (Non-CME)
Continental Ballroom 6
8:00 AM – 9:40 AM Postgraduate Course Track I (SAM) – Fetal
Continental Ballroom 4&5
8:00-8:10 a.m. Twin-Twin Complications – How To
Amy R. Mehollin-Ray, MD
8:10-8:20 a.m. Twin-Twin Complications – Cases
Edward R. Oliver, MD, PhD
8:20-8:30 a.m. Fetal Bowel – Imaging Updates and How to Do, Interpret & Report
Teresa Victoria, MD, PhD
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S51
8:30-8:40 a.m. Fetal Bowel – Cases
Brandon P. Brown, MD, MA, FAAP
8:40-8:50 a.m. Placental Invasion Disorders – How To
Luis F. Goncalves, MD
8:50-9:00 a.m. Placental Invasion Disorders – Cases
Mariana L. Meyers, MD
9:00-9:10 a.m. Radiologic Approach: Fetal Ventriculomegaly
Sarah S. Milla, MD, FAAP
9:10-9:20 a.m. Challenging Cases in the Fetal Abdomen
Christopher I. Cassady, MD, FAAP
9:20-9:40 a.m. Discussion
8:00 AM – 9:40 AM Postgraduate Course Track II (SAM) – MSK in the ED
Continental Ballroom 6
8:00-8:10 a.m. Radiologic Approach: Child with Acute and Painful Limping
Kieran J. Frawley, MBBS
8:10-8:20 a.m. Pelvis Fractures: How To
Arthur B. Meyers, MD
8:20-8:30 a.m. Pelvis Fractures: Cases
Matthew R. Hammer, MD
8:30-8:40 a.m. Sickle Cell Patient with Bone Pain – How To
Mahesh M. Thapa, MD
8:40-8:50 a.m. Sickle Cell Patient with Bone Pain - Cases
Bamidele F. Kammen, MD
8:50-9:00 a.m. Soft Tissue – Trauma vs. Infection – How To
Andrew S. Phelps, MD
9:00-9:10 a.m. Soft Tissue – Trauma vs. Infection - Cases
Delma Y. Jarrett, MD
9:10-9:20 a.m. Challenging Extremity Trauma Radiographs
Erika Rubesova, MD
9:20-9:40 a.m. Discussion
9:40 AM – 10:20 AM Break – Golden Gate Ballroom
10:20 AM – 12:00 PM Postgraduate Course Track I (SAM) – Updates on Ultrasound
Continental Ballroom 4&5
10:20-10:30 a.m. Contrast-enhanced US of Solid Mass – How To
Susan J. Back, MD
10:30-10:40 a.m. Contrast-enhanced US of Solid Mass - Cases
Judy H. Squires, MD
10:40-10:50 a.m. Liver Transplant Doppler – How To
Rama S. Ayyala, MD
10:50-11:00 a.m. Liver Transplant Doppler - Cases
Michael R. Acord, MD
11:00-11:10 a.m. Lung US – How To
Monica Epelman, MD
11:10-11:20 a.m. Lung US - Cases
Brian D. Coley, MD, FACR, FAIUM
11:20-11:30 a.m. Radiologic Approach to Renal Doppler – When Is It Helpful?
Harriet J. Paltiel, MD
11:30-11:40 a.m. Challenging Cases of Thyroid Sonography (TI-RADS)
Jennifer E. Lim-Dunham, MD, FACR
11:40 a.m.-12:00 p.m. Discussion
10:20 AM – 12:00 PM Postgraduate Course Track II (SAM) – NAT
Continental Ballroom 6
10:20-10:30 a.m. Radiologic Approach: Young Child with Healing Fractures
Ellen S. Park, MD, MS
10:30-10:40 a.m. Warning Signs of NAT in Infant Head Trauma
Teresa Chapman, MD, MA
10:40-10:50 a.m. Differential Diagnosis of NAT in Infant Head Trauma
Giulio Zuccoi, MD
10:50-11:00 a.m. Skeletal Trauma in NAT: Common and Uncommon Skeletal Injuries in NAT
Lydia Bajno, MD
11:00-11:10 a.m. Skeletal Trauma in NAT: How Old is the Injury?
Andy Tsai, MD, PhD
11:10-11:20 a.m. Abdominal and Pelvic Injuries in NAT – How To
HaiThuy N. Nguyen, MD
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S52
11:20-11:30 a.m. Abdominal and Pelvic Injuries in NAT - Cases
Aparna Joshi, MD
11:30-11:40 a.m. Radiologic Approach: Child with Skull Base Trauma
Mai-Lan Ho, MD
11:40 a.m.-12:00 p.m. Discussion
12:00 PM Postgraduate Course Adjourns
12:00 PM – 1:30 PM Lunch on Your Own
ANNUAL MEETING PROGRAM
12:00 PM – 1:30 PM 3D Read with the Experts (Non-CME)
Continental Ballroom 2&3
Moderators: Dianna M. E. Bardo, MD & Mark Ferguson, MD
12:00 PM – 1:30 PM CT Protocol Session (Non-CME)
Continental Ballroom 7&8
Moderators: Prakash Masand, MD & John D. MacKenzie, MD & Grace Phillips, MD
12:00-12:05 p.m. Welcome & Introduction
12:05-12:13 p.m. Physics of Dual Energy CT
Robert MacDougall, MSc
12:13-12:21 p.m. Dual Energy for Oncology – Initial Diagnosis
Grace Phillips, MD
12:21-12:29 p.m. Spectral dual-energy CT in a Pediatric Department: How, Why and at What Cost?
Richard Southard, MD
12:29-12:37 p.m. Ultrafast Chest CT Obviating the Need for Sedation
Sjirk J. Westra, MD, FACR
12:37-12:45 p.m. Enteric Contrast Optimization for CT Enterography
Joo Y. Cho, MD
12:45-12:53 p.m. Tips and Tricks for a Successful Pediatric CTA – Part I
Jason P. Weinman, MD
12:53-1:01 p.m. Tips and Tricks for a Successful Pediatric CTA – Part II
Tushar Chandra, MBBS, MD
1:01-1:30 p.m. Discussion/Vendor Q&A
1:30 PM – 2:30 PM Annual Meeting Welcome & Neuhauser Lecture
Continental Ballroom 4&5
1:30-1:35 p.m. 2019 Welcome Address
Taylor Chung, MD, SPR President
1:35-2:30 p.m. Edward B. D. Neuhauser Lecture – Deep Visual Understanding from Deep Learning
Jitendra Malik, PhD, Professor, Department of Electrical Engineering & Computer Science,
University of California at Berkeley
2:30 PM – 3:30 PM Artificial Intelligence: A Real Assistant for Imagers
Continental Ballroom 4&5
Moderator: Shreyas S. Vasanawala, MD, PhD, Radiologist & Scientist, Stanford University
2:30-2:40 p.m. Landscape & Introduction
Shreyas S. Vasanawala, MD, PhD, Radiologist & Scientist, Stanford University
2:40-2:55 p.m. Learning to Create Images
Joseph Cheng, PhD, Senior Scientist, Stanford University
2:55-3:10 p.m. Speeding up Imaging Segmentation
Akshay Chaudhari, PhD, Post-doctoral Scholar, Stanford University
3:10-3:25 p.m. Autonomous Image Acquisition (Non-CME)
Juan Santos, PhD, Scientist & Founding CEO HeartVista
3:25-3:30 p.m. Discussion
3:30 PM – 4:00 PM Exhibit Hall Kick-off Party
Golden Gate Ballroom
Join us as we welcome the 2019 SPR Exhibitors!
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S53
4:00 PM – 5:15 PM Scientific Session I-A: Gastrointestinal
Continental Ballroom 4&5
Moderators: Michael S. Gee, MD, PhD & Sudha A. Anupindi, MD
4:00 p.m. Paper #: 001 Karmazyn, Boaz Pilot study on contrast enhanced ultrasound in children post liver
transplant
4:10 p.m. Paper #: 002 Khanna, Geetika To evaluate rates of gadoxetate disodium induced transient severe
respiratory motion artifact in children
4:20 p.m. Paper #: 003 Gilligan, Leah Comparison of Navigator-Gated and Breath-Held Image
Acquisition Techniques for Multi-echo Quantitative Dixon Imaging
of the Liver in Children and Young Adults
4:30 p.m. Paper #: 004 Grasparil, Angela Don II Low b-value diffusion-weighted images detect significantly more
hyperintense liver lesions in children than T2-weighted images.
4:40 p.m. Paper #: 005 McCleary, Brendan Normal Pancreatic Parenchymal Volume in Heathy Children
4:50 p.m. Paper #: 006 McCleary, Brendan Assessment of Normative Cut-offs for Pancreas Thickness and T1
Signal Ratios in the Pediatric Pancreas
5:00 p.m. Paper #: 007 Gilligan, Leah Magnetic Resonance Imaging T1 Relaxation Times for the Liver,
Pancreas, and Spleen in Healthy Children at 1.5 and 3T
4:00 PM – 5:15 PM Scientific Session I-B: Interventional
Continental Ballroom 6
Moderators: Leah E. Braswell, MD & Timothy R. Singewald, MD
4:00 p.m. Paper #: 008 Sharma, Karun Development of MRI-compatible Robots for MRI-Guided
Procedures in Pediatric Interventional Radiology
4:10 p.m. Paper #: 009 Dao, Kimberly Sclerotherapy of Aneurysmal Bone Cysts: MRI Imaging Findings
and Clinical Outcomes
4:20 p.m. Paper #: 010 Shah, Jay Long-term Results and Durability of Cryoablation of Osteoid
Osteoma in the Pediatric and Adolescent Population
4:30 p.m. Paper #: 011 Jain, Neil Image-guided biopsy for suspected pediatric osteomyelitis: analysis
of experience
4:40 p.m. Paper #: 012 Pezeshkpour, Paymum Ultrasound-Guided Synovial Biopsy in Children
4:50 p.m. Paper #: 013 Escobar, Fernando Complex Cystic Thyroid Nodule Fine Needle Biopsies in Chidlren
– Experience in a Tertiary Pediatric Center
5:00 p.m. Paper #: 014 Durand, Rachelle Novel Approach to Increase Technical Success during Pediatric
Percutaneous Gastrostomy/Gastrojejunostomy Tube Placement
using Transgastric Balloon Occlusion
4:00 PM – 5:15 PM Scientific Session I-C: Informatics, Education, Policy
Continental Ballroom 2&3
Moderators: Scott R. Dorfman, MD & Alexander J. Towbin, MD
4:00 p.m. Paper #: 015 Kwon, Jeannie Bridging the Barriers for Better Team-Based Patient Care by
Incorporating NICU Radiology Tele-rounds
4:10 p.m. Paper #: 016 Kirby, Courtney Implementing the “What-Where-When” approach to improve
patient history availability at the time of radiograph interpretation
4:20 p.m. Paper #: 017 White, Ammie Effect of a Double-Interpretation Skeletal Survey Program on Child
Abuse Evaluations
4:30 p.m. Paper #: 018 Utama, Evelyn Gabriela Effectiveness of showing an interactive animated video vs regular
animated video in improving children’s cooperativeness during
MRI scan: a prospective, randomized, non-inferiority trial
4:40 p.m. Paper #: 019 Gokli, Ami Improved Workflow with MRI Protocol Optimization and
Technologist Education
4:50 p.m. Paper #: 020 Zumberge, Nicholas Wait Time Reduction for Sedated MRIs
5:00 p.m. Paper #: 021 Khwaja, Asef Pediatric Emergency Medicine Point of Care Ultrasound Impact on
Radiology Ultrasound Volume
5:15 PM Sessions Adjourn
5:15 PM – 7:00 PM Awards Ceremony
Continental Ballroom 4&5
7:00 PM – 8:00 PM 2019 Annual Meeting Welcome Reception
East Lounge
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S54
THURSDAY, MAY 2
6:45 AM – 8:00 AM Continental Breakfast & Exhibit Hall – Golden Gate Ballroom
8:00 AM – 11:59 PM Cases of the Day Online Activity
7:00 AM – 8:20 AM Sunrise Session I - Creating a Research Infrastructure
Continental Ballroom 2&3
. Moderators: Amie S. Robinson, BSRT, (R) (MR) CCRP & Shireen Hayatghaibi, MA, MPH
7:00-7:15 a.m. Chief’s Perspective/Providing Value through Research
Rajesh Krishnamurthy, MD
7:15-7:30 a.m. Research Types
Raymond W. Sze, MD
7:30-7:40 a.m. Administrative Do’s and Don’ts
Amie S. Robinson, BSRT, (R)(MR)CCRP & Sherwin S. Chan, MD
7:45-7:55 a.m. Developing a Curriculum for Trainees
Andrew T. Trout, MD
7:55-8:05 a.m. Measuring Success with Key Metrics
Shireen Hayatghaibi, MA, MPH
8:05-8:20 a.m. Leveraging Your Resources and Talents
Douglas C. Rivard, DO
7:00 AM – 8:20 AM Sunrise Session II – WFPI
Continental Ballroom 7&8
. Moderator: Dorothy I. Bulas, MD, FACR
7:00-7:05 a.m. Introduction
M. Ines Boechat, MD, FACR
7:05-7:25 a.m. Pediatric Radiology Education & Innovation in China
Yumin Zhong, MD, PhD
7:25-7:35 a.m. Innovation in Africa using Artificial Intelligence as a Sustainable Solution for Healthcare
Jaishree Naidoo, FCRad
7:35-7:45 a.m. Challenges of Ensuring Radiation Safety in Low Resource Settings
Monica Atalabi, MD
7:45-7:50 a.m. Update in WFPI Fellowship Initiatives
Jaishree Naidoo, FCRad
7:50-8:10 a.m. Innovation Outreach Initiatives – Top 5 Recommendations
Dorothy I. Bulas, MD, FACR, FAAP
Rwanda Experience – George A. Taylor, MD, FACR
Mozambique Experience – Ricardi Faingold, MD
Tanzania Experience – Sjirk J. Westra, MD, FACR
8:10-8:20 a.m. Discussion
7:00 AM – 8:20 AM Sunrise Session III – Professionalism
Continental Ballroom 1
. Moderator: Brandon P. Brown, MD, MA, FAAP
7:00-7:15 a.m. Burnout in Pediatric Radiology
Rama S. Ayyala, MD
7:15-7:30 a.m. Customer Service in Radiology
Alexander J. Towbin, MD
7:30-7:50 a.m. What Your Hospital/Chief Wants From You
George S. Bisset, MD, FACR
7:50-8:05 a.m. The Changing Workforce in Radiology
Jane C. Cook, DO
8:05-8:20 a.m. Building a Culture of Professionalism
Brandon P. Brown, MD, MA, FAAP
7:00 AM – 8:20 AM Sunrise Session IV – What’s New That Radiation Can Do For You
Continental Ballroom 6
. Moderator: Steven Don, MD
7:00-7:20 a.m. Spectral CT – Applications in Pediatric Radiology
Nicholas Rubert, PhD
7:20-7:35 a.m. Clinical Case Utilization of Spectral CT Applications
Richard Southard, MD
7:35-7:50 a.m. DECT in Clinical Practice
Erica L. Riedesel, MD
7:50-8:05 a.m. Update on Digital Radiography: What’s New?
Steven Don, MD
8:05-8:20 a.m. 3D and Videofluoroscopy Techniques in Pediatric Radiology
Benjamin Thompson, DO
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S55
7:00 AM – 8:20 AM Sunrise Session V – Learn From the Experts
Continental Ballroom 6
. Moderators: George A. Taylor, MD, FACR & Alan S. Brody, MD
7:00-7:15 a.m. What Were We Thinking?
James E. Crowe, MD
7:15-7:30 a.m. Career Lessons – Thoughts on Leadership
George A. Taylor, MD, FACR
7:30-7:45 a.m. Keeping Things in Perspective
Alan E. Schlesinger, MD
7:45-8:00 a.m. Lessons: The Good, The Bad and The Ugly
Alan S. Brody, MD
8:00-8:15 a.m. Retirement Starts at 30
Bruce R. Parker, MD, FACR
8:15-8:20 a.m. Q&A
8:30 AM – 10:20 AM Scientific Session II-A: Genitourinary
Continental Ballroom 4&5
Moderators: Ronald A. Cohen, MD & Patricia T. Acharya, MD
8:30 a.m. n/a Keynote Presentation Interesting Pediatric Urology Cases – How Imaging Can
Help - Laurence Baskin, MD, Oakland-San Francisco
8:50 a.m. Paper #: 022 Shapira – Zaltsberg, Gali Non-visualization of the ovaries on pediatric transabdominal
Ultrasound with a non-distended bladder: can adnexal torsion
be excluded?
9:00 a.m. Paper #: 023 Wishah, Fidaa Introduction of Contrast enhanced voiding urosonography
into clinical practice: Assessment of Clinical Indications,
Imaging results, and Urologist Acceptance.
9:10 a.m. Paper #: 024 Shellikeri, Sphoorti 3D printed anatomic contrast enhanced voiding
urosonography (ceVUS) teaching phantoms: bringing
pediatric vesicoureteral reflux (VUR) to life
9:30 a.m. Paper #: 026 Chow, Jeanne Comparison of glomerular filtration rate estimated by
motion-robust high spatiotemporal resolution dynamic
contrast enhanced MRI and plasma clearance of 99mTc-
DTPA
9:40 a.m. Paper #: 027 Grehten, Patrice Correlation of MR-Urography and intravoxel incoherent
motion MRI based estimation of split renal function in the
pediatric clinical population
9:50 a.m. Paper #: 028 Calle Toro, Juan Identifying Calyceal Diverticula at Magnetic Resonance
Urogram in Children
10:00 a.m. Paper #: 029 Sandberg, Jesse Distinguishing clinical and imaging characteristics of
nephrogenic rest vs. small Wilms tumor: a report from the
Children’s Oncology Group
10:10 a.m. Paper #: 030 Silvestro, Elizabeth Enhancing Presurgical 3D Modeling and Printing:
Multiphase MRI Technique
8:30 AM – 10:20 AM Scientific Session II-B: Cardiovascular/Education
Continental Ballroom 6
Moderators: Rajesh Krishnamurthy, MD & Karen Lyons, MD
8:30 a.m. n/a Keynote Presentation Stem Cell Therapy for Patients with Single Ventricle - Shunji
Sano, MD, PhD, San Francisco-Oakland
8:50 a.m. Paper #: 031 Mercado, Maria-Gisela Adolescents With Obesity:Carotid Intima Media Thickness
(cIMT) and Cardiovascular (CV) Risk Factors
9:00 a.m. Paper #: 032 Cohen, Sara Longitudinal Assessment of Imaging Features of Generalized
Arterial Calcification of Infancy
9:10 a.m. Paper #: 033 Jadhav, Siddharth Value of emergent pediatric cardiac computed tomographic
angiography service: Initial experience at a large children’s
hospital.
9:20 a.m. Paper #: 034 Cervantes, Luisa Intravenous Contrast Material Injection Protocol for Coronary
CTA in Children: Changing The Paradigm From Contrast
Volume To Injection Duration
9:30 a.m. Paper #: 035 Barrera, Christian Contrast extravasation using power injectors for contrast-
enhanced computed tomography in children: Safety profile and
injury severity assessment
9:40 a.m. Paper #: 036 Barrera, Christian Diagnostic performance of CT Angiography to detect
pulmonary vein stenosis in children
9:50 a.m. Paper #: 037 Zucker, Evan Feasibility and Utility of Dual-Energy Chest CTA for
Preoperative Planning in Pediatric Pulmonary Artery
Reconstruction
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S56
10:00 a.m. Paper #: 038 Jadhav, Siddharth Correlation of ductus arteriosus length and morphology
between computed tomographic angiography and catheter
angiography and their relation to ductal stent length
10:10 a.m. Paper #: 039 Caro Domínguez, Pablo Blood flow redistribution in fenestrated and completed Fontan
circulations: With special emphasis on abdominal flow
8:30 AM – 10:20 AM Scientific Session II-C: Interventional Radiology
Continental Ballroom 7&8
Moderators: Ahmad L. Alomari, MD & Anne Gill, MD
8:30 a.m. Keynote Presentation Angioarchitecture and the Imaging of Vascular
Malformations - Patricia E. Burrows, MD,
St. Petersburg
8:50 a.m. Paper #: 040 Durand, Rachelle Sirolimus treatment for complex lymphatic malformations in
children
9:00 a.m. Paper #: 041 Vatsky, Seth Three-dimensional (3D) printed pediatric endovascular
phantom for simulating vascular interventions - A feasibility
study
9:10 a.m. Paper #: 042 Srinivasan, Abhay Percutaneous transluminal angioplasty in children with Reno
vascular hypertension, experience in a tertiary pediatric
institution.
9:20 a.m. Paper #: 043 Srinivasan, Abhay Adjunctive Cutting Balloon Angioplasty in Children with
Resistant Renal Artery Stenosis – Experience on a Tertiary
Pediatric Institution.
9:30 a.m. Paper #: 044 Shah, Jay Catheter-directed pharmacologic thrombolysis for acute
submassive and massive pulmonary emboli in children and
adolescents.
9:40 a.m. Paper #: 045 Bertino, Frederic Technical feasibility and clinical efficacy of common iliac
vein stenting in adolescent patients with May-Thurner
Syndrome
9:50 a.m. Paper #: 046 Cleveland, Heather Split Liver vs Whole Liver OLT: Technical Demands of
Pediatric Portal Vein Recanalization
10:00 a.m. Paper #: 047 Kim, Yu Jin Comparison of Modified Single Puncture Technique for
Tunneling Short-term Central Venous Catheter with
Peripherally Inserted Central Catheter in Pediatric Group: A
Preliminary Study.
10:10 a.m. Paper #: 048 Yen, Christopher Outcomes of tunneled internal jugular venous catheters in
children younger than 6 months of age
8:30 AM – 10:20 AM Technologist Program – Session I
Continental 9
Moderator: Laura Gruber, MBA, RT(R), RDMS, RVT
8:30-8:50 a.m. Ice Breaker
Nikki D. Butler, BmSc, RT(R)(QM), HACP
8:50-9:05 a.m. Transitioning From Adults to Pediatrics
Gabe Linke, BSRT (R)(MR)
9:05-9:20 a.m. Strategies for Imaging Patients with Special Needs
Merima Karastanovic, MS, RT(R)(MR)
9:20-9:35 a.m. Why Do I Need to Look at Other Imaging Studies Prior to Performing Exams?
Patricia Lacy Gander, BS, RDMS, RVT, RT
9:35-9:50 a.m. Struggles of Anesthesia
Christine Harris, RT (MR) MRSO
9:50-10:05 a.m. Slight of the Hand Scheduling Magic
Angela Quintello, AAS
10:05-10:20 a.m. Gad Dep in the Pediatric Population
Charles Stanley
10:20 AM – 10:50 AM Break in Exhibit Hall – Golden Gate Ballroom
10:50 AM – 12:00 PM Midday Session I – Heartless Vascular Imaging
Continental 4&5
. Moderator: Prakash M. Masand, MD
10:50-11:05 a.m. Ferumoxytol/Feraheme Contrast for MRA
Dianna M.E. Bardo, MD
11:05-11:20 a.m. Contrast-enhanced Body MRA in Children: Techniques and Indications
Ladonna J. Malone, MD
11:20-11:30 a.m. Blood Pool Contrast for Abdominal MRA Post Ablavar
Lindsay Griffen, MD
11:30-11:45 a.m. Contrast and Non-contrast Extremity MRA
Michael A. Breen, MBBCh
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S57
11:45 a.m.-12:00 p.m. MR Lymphangiography
Govind B. Chavhan, MD
10:50 AM – 12:00 PM Midday Session II – Incidentalomas
Continental 7&8
. Moderator: R. Paul Guillerman, MD
10:50-11:05 a.m. Neuroradiology
Laura Hayes, MD
11:05-11:20 a.m. Musculoskeletal
Lauren W. Averill, MD
11:20-11:30 a.m. Chest
Paul G. Thacker, MD, MHA
11:30-11:45 a.m. Gastrointestinal
Martha M. Munden, MD 11:45 a.m.-12:00 p.m. Genitourinary
R. Paul Guillerman, MD
10:50 AM – 12:00 PM Midday Session III – Pearls in Neonatal Ultrasound
Continental Ballroom 2&3
. Moderator: Monica Epelman, MD & Rama S. Ayyala, MD
10:50-11:05 a.m. US for Necrotizing Entercolitis: Utility and Pitfalls
Cicero T. Silva, MD
11:05-11:20 a.m. Head US in HIE in Term Infants
Monica Epelman, MD
11:20-11:35 a.m. Utility of Supplemental Views for Head US in Preterm Infants
Rama S. Ayyala, MD
11:35-11:45 a.m. US of Diaphragm
Brooke S. Lampl, DO 11:45 a.m.-12:00 p.m. US of Brachial Plexus
Ramesh S. Iyer, MD
10:50 AM – 12:00 PM Midday Session IV – Noninterpretive Skills
Continental Ballroom 1
. Moderator: Richard E. Heller III, MD, MBA
10:50-11:05 a.m. Communication
George S. Bisset, MD, FACR
11:05-11:20 a.m. Presentation Skills
Richard E. Heller III, MD, MBA
11:20-11:30 a.m. Time Management
Jonathan R. Dillman, MD, MSc
11:30-11:40 a.m. Faculty Development
Brian D. Coley, MD, FACR, FAIUM 11:40 a.m.-12:00 p.m. Leading As a Pediatric Radiologist
Richard B. Gunderman, MD, PhD, FACR
10:50 AM – 12:00 PM Midday Session V – CEUS Technique and Applications
Continental Ballroom 6
. Moderators: Kassa Darge, MD, PhD & M. Beth McCarville, MD
10:50-11:00 a.m. Contrast US of the Brain
Misun Hwang, MD
11:00-11:10 a.m. Contrast US of the Liver
Jeannie K. Kwon, MD
11:10-11:20 a.m. Contrast US of the Spleen, Kidney and Co.
Patricia T. Acharya, MD
11:20-11:30 a.m. CEUS Bowel
Ami Gokili, MD 11:30-11:40 a.m. Contrast US of the Hip Joint
Susan J. Back, MD
11:40-11:50 a.m. Contrast enhanced Voiding Urosonography
Jeanne “Mei-Mei” S. Chow, MD 11:50 a.m.-12:00 p.m. Contrast US for Interventional Radiology
Michael R. Acord, MD
10:50 AM – 12:00 PM Technologist Program – Session II
Continental Ballroom 9
Moderator: Trista Raymer Maule, RT(R)(CT)(MR)MRSO
10:50-11:10 a.m. MRI Imaging of Cochlear Implants
Christina Sammet, PhD
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S58
11:10-11:30 a.m. US TCD in Ages 1-4
Brandi Kozak, BS, RDMS
11:30 a.m.-12:00 p.m. Interesting Uses of Imaging (Mummy Experience and Cadaver Imaging)
Gabe Linke, BSRT (R)(MR)
12:00 PM – 1:30 PM Lunch on Your Own
12:00 PM – 1:30 PM MR Protocol Session (Non-CME)
Continental Ballroom 7&8
Moderators: Michael S. Gee, MD, PhD, Govind Chavhan, MD &
Shreyas S. Vasanawala, MD, PhD
1:30 PM – 2:40 PM REF Research in Action
Continental Ballroom 4&5
Moderator: J. Damien Grattan-Smith, MBBS
1:30-1:50 p.m. Keynote Presentation: Towards Pediatric Body MR without Anesthesia
Michael “Miki” Lustig, PhD, Associate Professor, Department of Electrical Engineering &
Computer Science, UC Berkeley
1:50-1:58 p.m. Education Project Grant – “Facilitating a Pediatric Radiology Curriculum in the Global
Health Setting Using Tablet Computers”
Jennifer L. Nicholas, MD, MHA
1:58-2:06 p.m. Education Project Grant – “Pediatric Cardiovascular CT: A Faculty Development
Initiative”
Lorna P. Browne, MD, FRCR
2:06-2:14 p.m. Seed Grant – “Feasibility of contrast-enhanced Transfontanelle Ultrasound: Comparison
with Magnetic Resonance Imaging in the Neonate”
Judy H. Squires, MD
2:14-2:22 p.m. Young Investigator Award – “In vivo Tau Imaging using 18F-AV-1451 PET Radioligand in
a Swine Model of Closed Head Injury”
Neha S. Kwatra, MD
2:22-2:30 p.m. Multi-Institutional Pilot Award – “Determination of Normal Liver Stiffness by MR
Elastography in Children”
Andrew T. Trout, MD
2:30-2:40 p.m. Wrap-up & Announcements
J. Damien Grattan-Smith, MBBS
2:40 PM – 3:30 PM Pediatric Radiology Jeopardy
Continental Ballroom 4&5
Host - Richard E. Heller III, MD, MBA
Hall of Fame Team – Captain - Dorothy I. Bulas, MD, FACR, FAAP
Marta Hernanz-Schulman, MD, FACR, George Taylor, MD, FACR
& Brian D. Coley, MD, FACR, FAIUM
All-Star Team – Captain - Jonathan R. Dillman, MD
Rama Ayyala, MD, Sarah Milla, MD, FAAP & R. Paul Guillerman, MD
1:30 PM – 3:30 PM Technologist Program – Session III
Continental Ballroom 9
Moderator: Christine Harris, RT (MR) MRSO
1:30-2:15 p.m. Hot Topics
2:15-3:30 p.m. Scientific Abstract Presentations
2:15 p.m. Paper #: 001(T) Moore, Theresa Upper gastrointestinal studies indeterminate for malrotation: Are
there opportunities for improvement?
2:25 p.m. Paper #: 002(T) Munyon, Roxanne The Importance of Proper Patient Positioning and Immobilization in
Suspected Non-Accidental Trauma Cases
2:35 p.m. Paper #: 003(T) Silvestro, Elizabeth Running a Hospital in-house3d printing lab: Challenges and
Considerations
2:45 p.m. Paper #: 004(T) Silvestro, Elizabeth Application of 3D Printing and Mold Making to construct custom
Phantoms and Task Trainers
2:55 p.m.. Paper #: 005(T) Prevett, Georgina Innovating Change in Imaging for Patient Care
3:05 p.m. Paper #: 006(T) Goehner, Melissa Staff Engagement and the Correlation with Increasing Customer
Service
3:15 p.m. Paper #: 007(T) Shipp, Rozalon Regulartory Readiness: Preparing Diaganostic Imaging for Joint
Commission Accreditation
3:30 PM – 4:00 PM Exhibit Hall Break – Golden Gate Ballroom
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S59
4:00 PM – 5:40 PM Scientific Session III-A: Neuroradiology/Cardiology
Continental Ballroom 4&5
Moderators: Susan Palasis, MD & Skorn Ponratana, MD, MPH
4:00 p.m. Paper #: 049 Zafer, Rizwan Evaluation of Automated Extraction of Velocity Envelope for
Transcranial Doppler Ultrasound
4:10 p.m. Paper #: 050 El-Ali, Alexander Shear Wave Elastography in Brain Ultrasonography: Initial
Experience and Utility in Detecting White Matter Disease
4:20 p.m. Paper #: 051 Choi, Jungwhan Review of Neck CTA Examinations for Soft Palate Injury and
Proposal of a New Targeted CTA Protocol
4:30 p.m. Paper #: 052 Little, Stephen Fissures of the annulus fibrosus and cervical cord anterior spinal
artery infarcts in children: telltale signs of fibrocarilaginous disc
emboli?
4:40 p.m. Paper #: 053 Bhatia, Aashim Clinical benefit of ferumoxytol whole body vascular imaging
including the central nervous system in pediatric patients
4:50 p.m. Paper #: 054 McAllister, Aaron Comparison of 2D Turbo-Spin-Echo BLADE and Spin-Echo Echo-
Planar Diffusion Weighted Brain MRI at 3 Tesla: Preliminary
Experience in Children
5:00 p.m. Paper #: 055 Tabari, Azadeh Evaluation of Highly Accelerated Wave-CAIPI Susceptibility-
Weighted Imaging (SWI) in the Non-Sedated Pediatric Setting:
Initial Clinical Experience
5:10 p.m. Paper #: 056 Tabari, Azadeh Comparison of Ultrafast Wave-CAIPI Magnetization-Prepared
Rapid Acquisition Gradient-Echo (Wave-MPRAGE) and Standard
MPRAGE in Non-Sedated Children:Initial Clinical Experience
5:20 p.m. Paper #: 057 Little, Stephen Bridging vein evaluation in suspected abusive head trauma: beyond
tadpoles and lollipops
5:30 p.m. Paper #: 058 Proisy, Maïa Facial hemangioma: risk of PHACE syndrome and associated
anomalies.
4:00 PM – 5:40 PM Scientific Session III-B: Musculoskeletal
Continental Ballroom 6
Moderators: John D. MacKenzie, MD & Jie C. Nguyen, MD, MS
4:00 p.m. Paper #: 059 Bowden, Jonathan Validation of Automated Analysis of Bone Age from Hand
Radiograph
4:10 p.m. Paper #: 060 Khandwala, Nishith Multi-institutional Implementation of an Automated Tool to Predict
Pediatric Skeletal Bone Age: How We Did It
4:20 p.m. Paper #: 061 Starosolski, Zbigniew Cross-validation of two Convolutional Neural Networks for
radiographic fracture detection
4:30 p.m. Paper #: 062 Starosolski, Zbigniew Improved accuracy for tibial fracture identification by a
convolutional neural network and transfer learning
4:40 p.m. Paper #: 063 Starosolski, Zbigniew Improved accuracy for recognition of pediatric long-bone fractures
in the setting of variable open growth plates by Convolutional
Neural Networks
4:50 p.m. Paper #: 064 Degnan, Andrew Underappreciated Elbow Fractures: Pediatric Radial Head and
Neck Fractures and Additional Fracture Associations
5:00 p.m. Paper #: 065 Edwards, Emily Utilizing 3D-Printed Models to Optimize Digital Tomosynthesis
for Pediatric Medial Epicondyle Elbow Fractures
5:10 p.m. Paper #: 066 Tsai, Andy Long Bone Growth and Skeletal Maturation Patterns of Children
with Progeria
5:20 p.m. Paper #: 067 Maza, Noor Can Ultrasound be reliably used to evaluate infants with DDH after
age 6 months without the use of plain film radiography?
5:30 p.m. Paper #: 068 Prince, Jeffrey Outcomes Measures Related to Care Process Models in the
Evaluation of Infants for Developmental Dysplasia of the Hips
4:00 PM – 5:40 PM Scientific Session III-C: ALARA/Gastrointestinal
Continental Ballroom 2&3
Moderators: Gary R. Schooler, MD & Heather Bray, MD
4:00 p.m. Paper #: 069 Benali, Sébastien Comparative dose and image quality evaluation for scoliosis
follow-up exams: assessment of standard and low-dose
modes of a slot-scan radiographic system
4:10 p.m. Paper #: 070 Snyder, Elizabeth Comparing Image Quality and Exposure Rates Between Flat
Panel Detectors and Image Intensifiers in Fluoroscopy
4:20 p.m. Paper #: 071 Ross, Steven Novel Use of Optical Video for Reducing Radiation Dose in
Pediatric Fluoroscopy
4:30 p.m. Paper #: 072 Don, Steven Efficient ALARA Determination using Adaptive Simulated
Low-Dose Pediatric Appendicitis CT and a Psychometric
Function
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S60
4:40 p.m. Paper #: 073 Finkle, Joshua Radiation burden associated with imaging of suspected
appendicitis-related abscess: Pathway to a radiation free MR
appendicitis imaging protocol
4:50 p.m. Paper #: 074 Southard, Richard Implementation of Single-Source Dual-Layer Spectral CT in
a Pediatric Imaging Department: Addressing Dose Neutrality
and Maintenance of Image Quality in Abdominal-Pelvic CT
in Children
5:00 p.m. Paper #: 075 Siegel, Marilyn Size-specific dose estimate reference levels for pediatric
abdominopelvic examinations using single and dual-energy
dual-source CT
5:10 p.m. Paper #: 076 Richer, Edward Plain film findings in ileocolic intussusception. Why should
we care?
5:20 p.m. Paper #: 077 Ma, Grace Recurrent Intussusceptions in Children
5:30 p.m. Paper #: 078 Tshuma, Makabongwe Piriform Fossa Sinus Tract - A 15 year retrospective review
of cases from birth to adolescence presenting to a Children's
Hospital
4:00 PM – 5:40 PM Technologist Program – Session IV
Continental Ballroom 9
Moderator: Laura Poznick, AAS, RDMS
4:00-4:20 p.m. MR Cardiac Pacemakers
Georgina Prevett, MS, RT(R)(N) (CT)(MR), CNMT(CT)
4:20-4:40 p.m. Innovation Meets Operations: Strategies in Building Interventional Labs
Kevin R. Shoaf ARRT RT(R)
4:40-5:00 p.m. MRI Safety Initiatives and Improvements
Katherine Busher, BS,RT(R)MR,MRSO
5:00-5:40 p.m. Scientific Abstract Presentations
5:00 p.m. Paper #: 008(T) Wilson, Justine MR Imaging of the Forgotten Circulation: Intrahepatic Dynamic
Contrast MR Lymphangiography (IH-DCMRL) to Evaluate the Liver
and Central Lymphatics
5:10 p.m.. Paper #: 009(T) Johnson, Maggie Move over wearable and embedded devices there a new MRI safety
challenge today call ingestible
5:20 p.m. Paper #: 010(T) Carson, Robert MRI Safety and the MRSO
5:30 p.m. Paper #: 011(T) Maule, Trista MRI Safety: Getting the FTEs You Need
5:40 PM Sessions Adjourn
FRIDAY, MAY 3
6:45 AM – 8:00 AM Continental Breakfast & Exhibit Hall – Golden Gate Ballroom
8:00 AM – 11:59 PM Cases of the Day Online Activity
7:00 AM – 8:20 AM WFPI Breakfast Get Together: Pediatric Radiology Outreach FAQ (Non-CME)
Continental Ballroom 1
Interested in outreach? Interested in learning what your colleagues in the World Federation of
Pediatric Imaging, an alliance of Pediatric Radiology organizations across the globe, are doing
and, if interested, how you could jump in? Pick up your breakfast from the hallway and join us
for an informal gathering of WFPI volunteers and supporters!
7:00 AM – 8:20 AM Sunrise Session VI – Thoracic Imaging
Continental Ballroom 4&5
. Moderator: Alan S. Brody, MD
7:00-7:15 a.m. Dynamic Airway Imaging
Pamela M. Ketwaroo, MD
7:15-7:35 a.m. What is Pneumonia and What Should We Do about It?
Alan S. Brody, MD
7:35-7:50 a.m. Pediatric Chest CTA
Karen Lyons MD, BCh, BAO
7:50-8:05 a.m. Functional Lung MRI: From Research Tool to Clinical Application
Talissa Altes, MD
8:05-8:20 a.m. Strategies for Optimizing Thoracic CT and MRI in Children
Sarah Desoky, MD
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S61
7:00 AM – 8:20 AM Sunrise Session VII – Hybrid Imaging
Continental Ballroom 6
. Moderator: Stephan D. Voss, MD, PhD
7:00-7:20 a.m. Hybrid Imaging in Pediatrics
Stephen D. Voss, MD, PhD
7:20-7:35 a.m. SPECT/CT ONC
Susan E. Sharp, MD
7:35-7:50 a.m. PET CT in Lymphoma
Pek-Lan Khong, MBBS, FRCR
7:50-8:05 a.m. PET and SPECT CT in Epilepsy
Jason N. Wright, MD
8:05-8:20 a.m. PET MR Oncology
Heike E. Daldrup-Link, MD, PhD
7:00 AM – 8:20 AM Sunrise Session VIII – Safety
Continental Ballroom 2&3
. Moderator: Michael J. Callahan, MD
7:00-7:15 a.m. Here’s Looking at You, CT
Donald P. Frush, MD, FACR
7:15-7:30 a.m. MRI Safety
Cory M. Pfeifer, MD, MS, FAAP
7:30-7:45 a.m. Gadolinium Deposition: Update
Alexander Radbruch, MD
7:45-8:00 a.m. Anesthesia Safety
Joshua Nickerson, MD
8:00-8:20 a.m. Putting It Together: Risk/Benefit of Abdominal MRI vs. CT in Young Pediatric Patients
Michael J. Callahan, MD
7:00 AM – 8:20 AM Sunrise Session IX – Radiogenomics
Continental Ballroom 7&8
. Moderator: Matthew A. Zapala, MD, PhD
7:00-7:15 a.m. Radiogenomics: A Primer and Initial Applications to Pediatric Radiology
Matthew A. Zapala, MD, PhD
7:15-7:30 a.m. Practical Radiomics and Radiogenomics Using Computational Pipelines
Sandy Napel, PhD
7:30-7:45 a.m. Radiogenomics in Pediatric Neuroradiology
Kristen Yeom, MD
7:45-8:00 a.m. Radiogenomics in the World of Nuclear Medicine
Spencer Behr, MD, PhD
8:00-8:20 a.m. Imaging Genomics in the Age of Bioinformatics, a Computational Perspective
Olivier Gavaert, PhD
8:30 AM – 10:20 AM Scientific Session IV-A: Nuclear/Oncology
Continental Ballroom 4&5
Moderators: Stephan D. Voss, MD, PhD & Adina L. Alazraki, MD
8:30 a.m. n/a Keynote Presentation Total-Body PET/CT: Simultaneous Imaging of the Entire Body with
EXPLORER - Ramsey Badawi, MD, PhD, Davis
8:50 a.m. Paper #: 079 Sher, Andrew Ultrafast PET/CT: A qualitative and quantitative analysis of reduced
imaging times using Digital PET/CT
9:00 a.m. Paper #: 080 Gillum, Jason Utility of 18F-FDG PET/CT following ketogenic diet in detecting
endocarditis in children and adult congenital heart disease patients.
9:10 a.m. Paper #: 081 Muehe, Anne Standardized Uptake Values on PET/MR scans are not affected by iron
oxide nanoparticles
9:20 a.m. Paper #: 082 Zapala, Matthew Radiomic analysis of staging CT scans for neuroblastoma: An initial
investigation of correlations with tumor histology, MYCN status, INRG
stage, relapse and death
9:30 a.m. Paper #: 083 Devkota, Laxman Monitoring Response to Immunotherapies in Neuroblastoma Using
Nanoparticle Contrast-Enhanced CT
9:40 a.m. Paper #: 084 Hasweh, Reem Gadolinium-based contrast media improve detection of image defined risk
factors at diagnosis of neuroblastoma
9:50 a.m. Paper #: 085 Grassi, Daphine The Structured Report for Oncology – An Important Tool for Oncologists
and Radiologists
10:00 a.m. Paper #: 086 Siedek, Florian Are Ferumoxytol-enhanced MRI scans equally suitable to evaluate tumor
size and extension of pediatric bone tumors compared to Gadolinium-
enhanced MRI scans?
10:10 a.m. Paper #: 087 Doria, Andrew Diagnostic Accuracy of Imaging Approaches for Early Tumor Detection in
Patients with Li-Fraumeni Syndrome
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S62
8:30 AM – 10:20 AM Scientific Session IV-B: Neonatal/Fetal/Neuroradiology
Continental Ballroom 6
Moderators: Misun Hwang, MD & Rama S. Ayyala, MD
8:30 a.m. n/a Keynote Presentation How Alterations of Normal Brain Development
Results in Malformations -James Barkovich, MD, Oakland-San Francisco
8:50 a.m. Paper #: 088 Rubesova, Erika Doppler imaging in hypoxic ischemic encephalopathy: What is the value of
the resistivity index with and without compression of the fontanel?
9:00 a.m. Paper #: 089 Zheng, Qiang Region-Specific Perfusion Alterations in Neonatal Hypoxic Ischemic
Injury Evaluated with Arterial Spin Labeling MRI
9:10 a.m. Paper #: 090 Proidy, Maïa Changes in brain perfusion in successive arterial spin labelling MRI scans
in neonates with hypoxic-ischemic encephalopathy
9:20 a.m. Paper #: 091 Zheng, Qiang Quantitative ASL Perfusion Method for Detection of Neonatal Hypoxic
Ischemic Injury as Reference Standard for Developing Contrast-Enhanced
Ultrasound
9:30 a.m. Paper #: 092 Cort, Kayla Contrast-enhanced ultrasound for the evaluation of neonatal brain injury:
Interpretation and implementation
9:40 a.m. Paper #: 093 Didier, Ryne Contrast-Enhanced Brain Ultrasound Perfusion Metrics in the EXTra-
uterine Environment for Neonatal Development (EXTEND): Correlation
with Hemodynamic Parameters
9:50 a.m. Paper #: 094 Parakh, Anushri Artificial Intelligence Detection of Germinal Matrix Hemorrhage on Head
Ultrasound Examinations Using Convolutional Neural Networks
10:00 a.m. Paper #: 095 Kralik, Stephen The Frontal Temporal and Frontal Occipital Horn Ratios in Pediatric
Hydrocephalus: Comparison and Validation of Head Ultrasound with
Volumetric Analysis via MRI
10:10 a.m. Paper #: 096 Didier, Ryne Incidence and Concordance of Suspected Intraventricular Hemorrhage
(IVH) on Fetal US and MRI in Open Spinal Dysraphism with Postnatal
Follow-Up
8:30 AM – 10:20 AM Scientific Session IV-C: Thoracic
Continental Ballroom 2&3
Moderators: Paul G. Thacker, MD, MHA & Ladonna J. Malone, MD
8:30 a.m. n/a Keynote Presentation Standardization of Postnatal CT Imaging and Interpretation of
Bronchopulmonary Malformations- Beverley Newman, MD, Stanford
8:50 a.m. Paper #: 097 Cort, Kayla Chest ultrasound for the screening and diagnosis of pulmonary
lymphangiectasia
9:00 a.m. Paper #: 098 Biko, David Contrast Enhanced Ultrasound (CEUS) Evaluation of Thoracic Duct Outlet
Patency After Percutaneous Injection of Intranodal Contrast
9:10 a.m. Paper #: 099 Wallace, Andrew Dual and Single Energy Pediatric Thoracic Computed Tomographic
Angiography: Effects on Radiation Dose and Imaging Quality
9:20 a.m. Paper #: 100 Agahigian, Donna Preoperative Visualization of the Artery of Adamkiewicz in Pediatric
Patients on Dynamic 4D airway CT angiograms
9:30 a.m. Paper #: 101 Shin, Su-Mi CT Angiographic Findings of Pulmonary Arteriovenous Malformations
(PAVM) in Children with Hereditary Hemorrhagic Telangiectasia (HHT):
Spectrum of PAVM and Correlation with Graded Transthoracic Contrast
Echocardiography (TTCE)
9:40 a.m. Paper #: 102 Mong, David Predictive model for pediatric pulmonary embolism risk utilizing semantic
data mapping, neural embedding technique, and recurrent neural network
9:50 a.m. Paper #: 103 Zeng, David Artificial Intelligence Correction of Image Artifacts for Faster Pediatric
Lung MRI
10:00 a.m. Paper #: 104 Ibrahim, Ala’ Imaging evaluation for thoracic spine fractures in pediatric trauma patients:
a single center experience at an academic children’s hospital
10:10 a.m. Paper #: 105 Grey, Neil Imaging Findings Following Button Battery Ingestions
8:30 AM – 10:20 AM Technologist Program – Session V
Continental Ballroom 9
Moderator: Tara Cielma, RDMS, RDCS, RVT, RT(S)
8:30-8:50 a.m. MSK Ultrasound
Parker Stanleym MHA, RDMS
8:50-9:10 a.m. LEAN in Nuclear Medicine
Joseph MacLean, MHA, CNMT
9:10-9:30 a.m. CT Dynamic Imaging
Erica Gates
9:30-10:20 a.m. Scientific Abstract Presentations
9:30 a.m. Paper #: 012(T) Riemann, Monique Ultrasound Imaging of Orthopedic Magnetically controlled Spinal Rods
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S63
9:40 a.m. Paper #: 013(T) Silvestro, Elizabeth Fabrication and utilization of an Ultrasound Phantom for young patient
engagement and understanding
9:50 a.m. Paper #: 014(T) Silvestro, Elizabeth Design and construction of an infant phantom for hip ultrasound education
and training
10:00 a.m. Paper #: 015(T) Morgan, Trudy Pulmonary Lymphangiectasia (PL) - Diagnosing with Ultrasound Instead
of MRI
10:10 a.m. Paper #: 016(T) Brondell, Ashley IVUS for Venous Compression Syndromes
10:50 AM – 12:00 PM Midday Session VI – Image Gently
Continental Ballroom 2&3
. Moderator: Donald P. Frush, MD, FACR
10:50-11:10 a.m. From Abbey Road to the Digital Highway: Update on Medical Radiation Exposure to
Children in the US
Donald P. Frush, MD, FACR
11:10-11:30 a.m. Help: Decision Support for Pediatric CT
Marta Hernanz-Schulman, MD, FACR
11:30-11:50 a.m. Get Back: Recommendations for Gonadal Shielding in Children
Keith J. Strauss, MSc, FACR
11:50 a.m.-12:00 p.m. Come Together: AI/Machine Learning in Radiology
Matthew P. Lungren, MD, PhD
10:50 AM – 12:00 PM Midday Session VII – Cardiac MR
Continental Ballroom 4&5
. Moderator: Lorna P. Browne, MD, FRCR
10:50-11:10 a.m. Crash Course in the Common Congenital Cardiac Surgeries
Lorna P. Browne, MD, FRCR
11:10-11:20 a.m. How Do I Start Incorporating T1 and T2 Mapping in to my Clinical Practice?
Christopher Z. Lam, MD
11:20-11:30 a.m. How Do I Start Scanning Pacemakers in my Clinical Practice?
Maryam Ghadami Mahani, MD
11:30-11:40 a.m. How Do I Start Incorporating 4D Flow into my Clinical Practice?
Cynthia K. Rigsby, MD, FACR
11:40-11:50 a.m. How Do I Image a Failing Fontan?
David M. Biko, MD
11:50 a.m.-12:00 p.m. Q&A
10:50 AM – 12:00 PM Midday Session VIII – Advanced Topics in Pediatric MRI
Continental Ballroom 6
. Moderator: Sarah D. Bixby, MD
10:50-11:05 a.m. Accelerated MSK MRI
Sarah D. Bixby, MD
11:05-11:20 a.m. Accelerated Body MRI
Michael S. Gee, MD, PhD
11:20-11:40 a.m. Accelerated Neuro MRI
Mai-Lan Ho, MD
11:40 a.m.-12:00 p.m. High Value MRI: What Does the Future Look Like?
Houchun H. Hu, PhD
10:50 AM – 12:00 PM Midday Session IX – Diagnostic Dilemmas/Questions
Continental Ballroom 1
. Moderator: Kirsten Ecklund, MD
10:50-11:05 a.m. Whole Body MRI vs. PET
Govind B. Chavhan, MD
11:05-11:20 a.m. When Do Cartilage Maps Actually Help
Diego Jaramillo, MD, MPH
11:20-11:35 a.m. Developments in Lung MRI
Shreyas S. Vasanawala, MD, PhD
11:35-11:50 a.m. Options for Scoliosis Imaging
Kirsten Ecklund, MD
11:50 a.m.-12:00 p.m. MRE – Do I Really Need 25 Sequences?
Prakash M. Masand, MD
10:50 AM – 12:00 PM Midday Session X – Value-Added Radiology
Continental Ballroom 7&8
. Moderator: David B. Larson, MD
10:50-11:00 a.m. Adding Value as a Consultant
Brandon P. Brown, MD, MA
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S64
11:00-11:15 a.m. Measuring the Value of Consultation
Nghia (Jack) Vo, MD
11:15-11:25 a.m. Time-Driven Activity-Based Costing
Robert C. Orth, MD, PhD
11:25-11:45 a.m. The Role of Technologist Education in Practice Reform
David B. Larson, MD
11:45 a.m.-12:00 p.m. Using Radiology Extenders to Add Value
Brandy Bales, RPA, RT(R)(M)
10:50 AM – 12:00 PM Technologist Program – Session VI Moderator: Patricia Lacy Gandor, BS, RDMS
10:50-11:10 a.m. PET/MR How to Decrease Overall Scan Time
Elad Nevo, MS, RT(MR)(N)(CT), CNMT
11:10-11:30 a.m. Comparison of Standard VCUG, ceVcug, Nuclear VCUG
Roxanne M. Munyon, BS/AS
Joseph Maclean, CNMT
Laura Poznick, AAS, RDMS
11:30 a.m.-12:00 p.m. Imaging Jeopardy
Nikki D. Butler, BMSc, RT(R)(QM)
12:00 PM – 1:30 PM Lunch on Your Own
12:00 PM – 1:30 PM SPR Business Meeting – SPR Members Only
Continental Ballroom 4&5
1:30 PM – 3:30 PM Scientific Session V-A: Fetal/Musculoskeletal
Continental Ballroom 4&5
Moderators: Carol E. Barnewolt, MD & Sarah J. Menashe, MD
1:30 p.m. n/a Keynote Presentation Fetal Imaging: Key to Fetal/Peri-natal Surgical Management in
2019? – Darrell L. Cass, MD, Cleveland
1:50 p.m. Paper #: 106 Estroff, Judy Unreliability of standard fetal imaging biomarkers for prediction of
lethal pulmonary hypoplasia (PH)
2:00 p.m. Paper #: 107 Atluri, Mahesh Attention-Aware Deep Learning Networks for Predicting Gestational
Brain Age Using Fetal MRI
2:10 p.m. Paper #: 108 Choi, Jungwhan Inner and external ear malformations as assessed on fetal ultrasound
and MRI
2:20 p.m. Paper #: 109 Barrera, Christian Comparison of SAR and SED between fetal MR imaging at 1.5T and
3T: Our experience with 3247 examinations
2:30 p.m. Paper #: 110 Badachhape, Andrew Determination of Placental Fractional Blood Volume in a Pregnant
Mouse Model
2:40 p.m. Paper #: 111 Spiller, Lisa Growth Recovery Lines: A Specific Indicator of Child Abuse and
Neglect?
2:50 p.m. Paper #: 112 Karmazyn, Boaz Establishing signs for acute and healing phases of classic metaphyseal
lesions
3:00 p.m. Paper #: 113 Messer, Diana A Systematic Review of Radiographic Time Since Injury Methods for
Pediatric Healing Fractures
1:30 PM – 3:30 PM Scientific Session V-B: Cardiovascular
Continental Ballroom 6
Moderators: Houchun Harry Hu, PhD & Christopher Z. Lam, MD
1:30 p.m. n/a Keynote Presentation Gadolinium Deposition in Children: Should we Worry? –
Alexander Radbruch, MD, Essen, Germany
1:50 p.m. Paper #: 115 Kelly, John Morphometry of a tissue engineered vascular graft (TEVG) by
multimodality imaging including MRI, intravascular ultrasound and
angiography in a translational sheep model
2:00 p.m. Paper #: 116 Biko, David Intrahepatic Dynamic Contrast Enhanced MR Lymphangiography: A
New Technique for Visualization of the Central Lymphatics
2:10 p.m. Paper #: 117 Pednekar, Amol Evaluation of Cumulative Perimetric Ratio as Quantitative Index for
Degree of Left ventricular Myocardial Trabeculations in Adolescents
and Young Adults
2:20 p.m. Paper #: 118 Pednekar, Amol Circumventing Anesthesia in Pediatric Cardiac Patients Considered
High-Risk for Anesthesia using Free Breathing CMR
2:30 p.m. Paper #: 119 Ponrartana, Skorn Non-contrast Flow-independent Relaxation-Enhanced MR
Angiography Using Inversion Recovery and T2-Prepared 3D mDIXON
Gradient-Echo DIXON Technique: Applications in the Pediatric
Population
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S65
2:40 p.m. Paper #: 120 Diaz, Eric Image Quality Assessment of Cardiothoracic Respiratory Motion
Compensated Relaxation Enhanced 3D Non-Contrast MRA with
Reference to Dynamic Contrast-Enhanced 3D MRA: A Pilot Study
2:50 p.m. Paper #: 121 Sandino, Christopher Highly accelerated cardiorenal 4D flow MRI using 3D cones trajectory
3:00 p.m. Paper #: 122 Bush, Adam Multi Echo fLow-encoded Rosette (MELROSE) for Quantitative
Assessment of Cardiac and Intravascular T2* and Blood Oxygen
Saturation Determination
3:10 p.m. Paper #: 123 Bush, Adam Contigious Rosette Echoes iN Single Highly Accelerated Acquistion
(CRENSHAA) for Motion Robust and Time Resolved Cardiac and
Abdominal T2* Assessment
3:20 p.m. Paper #: 124 Sandino, Christopher Deep learning-based reconstruction of 2D cardiac CINE MRI data
1:30 PM – 3:30 PM Scientific Session V-C: Neuroradiology
Continental Ballroom 2&3
Moderators: Ashok Panigrahy, MD & Hisham M. Dahmoush, MBBCh
1:30 p.m. n/a Keynote Presentation Immersive Virtual Reality Imaging in Pediatric Neurosurgery –
Kurtis Auguste, MD, Oakland – San Francisco
1:50 p.m. Paper #: 125 Chan, Alex The utility of the ASL sequence in parenchymal injury of the brain in
abusive head trauma (AHT).
2:00 p.m. Paper #: 126 Maleki, Maryam ASL Perfusion Imaging of the Frontal Lobes Predicts the Occurrence
and Resolution of Posterior Fossa Syndrome
2:10 p.m. Paper #: 127 Sarma, Asha Neuroimaging findings in infants with human parechovirus infection
2:20 p.m. Paper #: 128 Riotti, Jessica Longitudinal Brain MRI Characterization of Normal Appearing Zika-
exposed children using advanced MRI techniques and Correlations
with Neurodevelopmental Outcomes
2:30 p.m Paper #: 129 Chu, Zili Brain Network Architecture Correlates with Seizure-Free Outcome in
Children Undergoing Epilepsy Surgery
2:40 p.m. Paper #: 130 Coblentz, Ailish Using Connectome Mapping to Define a Target for Deep Brain
Stimulation in Paediatric Dystonia
2:50 p.m. Paper #: 131 Maloney, Ezekiel In the era of mTOR inhibitors for treatment of tuberous sclerosis
complex, is MRI surveillance of subependymal giant cell atrocytoma
growth reliable without gadolinium?
3:00 p.m. Paper #: 132 Maloney, Ezekiel Non-inferiority of a non-gadolinium-enhanced MRI follow up protocol
for isolated optic pathway gliomas – interim analysis from a multi-
reader-multi-case study
3:10 p.m. Paper #: 133 Ugas Charcape, Carlos Primary intracranial sarcoma in pediatrics: MRI findings
3:20 p.m. Paper #: 134 Teixeira, Sara Thalamic lesion in Leigh syndrome: An unusual finding mimicking
Percheron artery infarct
3:30 PM – 3:45 PM Break – East Lounge
3:45 PM – 5:45 PM Scientific Session VI-A: Musculoskeletal
Continental Ballroom 4&5
Moderators: Bamidele F. Kammen, MD & Mahesh M. Thapa, MD
3:45 p.m. n/a Keynote Presentation How Advanced Imaging Has Changed Surgical Practice in the
Age of Sports Specialization – Nirav Pandya, MD, Oakland
4:05 p.m. Paper #: 135 Tamir, Jon Introduction of Targeted Rapid Knee MRI exam using T2 Shuffling
into Clinical Practice: Retrospective Analysis on Image Quality, Cost
and Scan Time
4:15 p.m. Paper #: 136 Sandberg, Jesse Silent and Distortionless Diffusion MRI
4:25 p.m. Paper #: 137 Pezeshkpour, Paymun Novel Functional BOLD MR Imaging Techniques for Assessment of
Juvenile Dermatomyositis: Preliminary Results
4:35 p.m. Paper #: 138 Shet, Narendra MR-HIFU: What the Pediatric Radiologist Should Know
4:45 p.m. Paper #: 139 Matheney, Travis Intra-Operative Contrast-Enhanced Ultrasound of Infant Hips: A
Comparison with Post-Operative MRI and Correlation with
Development of Femoral Head Avascular Necrosis
4:55 p.m. Paper #: 140 Withdrawn
5:05 p.m. Paper #: 141 Hammer, Matthew A Multidisciplinary Approach Leads to More Efficient Magnetic
Resonance Imaging, Less Use of Contrast Material, and Improved
Clinical Outcomes During Musculoskeletal Infection Evaluation
5:15 p.m. Paper #: 142 Doria, Andrea Value of Functional T2 Map MRI in the Assessment of Early
Cartilage Degeneration of Pediatric Patients with Hemophilia
5:25 p.m. Paper #: 143 Xu, Lin Role of DWI in detecting early satage of sacroiliac joint lesions in
children with enthesitis related arthritis
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S66
5:35 p.m. Paper #: 144 Nguyen, Jie Stable versus unstable osteochondral lesions of the elbow:
Performance of MR imaging criteria for instability
3:45 PM – 5:45 PM Scientific Session VI-B: Gastrointestinal
Continental Ballroom B
Moderators: Govind Chavhan, MD & Ethan A. Smith, MD
3:45 p.m. n/a Keynote Presentation Advanced Imaging is Integral to the Clinical Care of Pediatric
Gastrointestinal, Hepatologic, and Pancreatic Diseases – Zachary
Sellers, MD, PhD, Stanford
3:55 p.m. Paper #: 145 Harris, Lisa Abdominal Wall Thickness in Children Correlates with Hepatic
Steatosis
4:05 p.m. Paper #: 146 Gee, Michael Automated Sonographic Assessment of Fatty Liver in Pediatric
Patients
4:15 p.m. Paper #: 147 Barrera, Christian Biexponential T2* relaxation model for estimation of liver iron
concentration in children: A better fit for high liver iron
concentrations
4:25 p.m. Paper #: 148 Calle Toro, Juan R2-Relaxometry MRI for estimation of Liver Iron Concentration. A
comparison between two methods.
4:35 p.m. Paper #: 149 Thompson, Benjamin Magnetic Resonance Elastography of the Liver in Children:
Variations in Regional Stiffness
4:45 p.m. Paper #: 150 Northern, Nathan Technical Success Rate of Two-Dimensional Ultrasound Shear Wave
Elastography in a Large Pediatric and Young Adult Population: A
Clinical Effectiveness Study
4:55 p.m. Paper #: 151 Sandberg, Jesse Biliary atresia versus other causes of neonatal jaundice: What is the
value of Shear Wave Elastography complementing grayscale
findings?
5:05 p.m. Paper #: 152 Shin, Hyun Joo Quantitative assessment of liver stiffness and perfusion using shear
wave elastography and dual energy computed tomography in hepatic
veno-occlusive disease in rabbit model
5:15 p.m. Paper #: 153 Trout, Andrew Normal Liver and Pancreas Shear Wave Stiffness in Healthy Children
5:25 p.m. Paper #: 154 Gilligan, Leah Use of Clinical and Quantitative Magnetic Resonance
Cholangiopancreatography Parameters for Differentiating
Autoimmune Liver Diseases
5:35 p.m. Paper #: 155 Marie, Eman How Can Criteria for Interpretation of MRI Examinations of
Appendicitis Influence Diagnostic Accuracy?
3:45 PM – 5:45 PM Scientific Session VI-C: Informatics/Educational
Continental Ballroom 2&3
Moderators: David B. Larson, MD, MBA & Michael M. Moore, MD
3:45 p.m. n/a Keynote Presentation The Sacred Work of Caring for Children – Richard B. Gunderman,
MD, PhD, FACR, Indianapolis
4:05 p.m. Paper #: 156 Hailu, Tigist Walk in My Shoes: Interdepartmental Role Shadowing to Develop
Workplace Wellness at a Large Pediatric Radiology Department
4:15 p.m. Paper #: 157 Ayyala, Rama Assessment of Factors Associated with Burnout and Wellness in
Pediatric Radiologists
4:25 p.m. Paper #: 158 Gokli, Ami Gender Representation in Recent SPR-Sponsored Events
4:35 p.m. Paper #: 159 Sammer, Marla Review of Learning Opportunity Rates: Correlation with Radiologist
Assignment, Patient Type, and Exam Priority
4:45 p.m. Paper #: 160 Gokli, Ami Teaching File: An Extensive Revision to Optimize Integration and
Educational Value
4:55 p.m. Paper #: 161 Gokli, Ami Multifaceted Educational Scaffolding Supports Sub-Specialization in
Pediatric Radiology
5:05 p.m. Paper #: 162 Reid, Janet RADIAL Learning Management System - One Year Later
5:15 p.m. Paper #: 163 Otero, Hansel Cost-Effectiveness Analysis in Pediatric Radiology: How the
Evidence (or, the Lack Thereof) Can Lead Future Research
5:25 p.m. Paper #: 164 Mesi, Erin Tackling the “black hole” of encounter specific quality improvement
data in imaging
5:35 p.m. Paper #: 165 Koci, Martin Comparison of Different Weight Groups in Pediatric Trauma Using
Split-bolus Single-pass Contrast CT protocol.
5:45 PM Sessions Adjourn
7:00 PM – 10:30 PM Reception & Annual Banquet – separate fee applies
Plaza Room
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S67
SATURDAY, MAY 4
7:00 AM – 8:00 AM Continental Breakfast – Golden Gate Ballroom
8:00 AM – 11:59 PM Cases of the Day Online Activity
7:00 AM – 8:00 AM US Protocol Session (Non-CME)
Golden Gate Ballroom
Moderators: Monica Epelman, MD & Andrew S. Phelps, MD
Ultrasound for necrotizing enterocolitis: protocol, pearls and pitfalls
Monica Epelman, MD
Ultrasound Technical Tips
Andrew S. Phelps, MD
Q&A with Vendors
8:00 AM – 12:00 PM Cardiac CT – Pre-registration required, Non-CME
Continental Ballroom 6
8:00-8:10 a.m. Welcome & Introductions
Lorna P. Browne, MD, FRCR
8:10-8:25 a.m. Cardiac CT – Technical Aspects
Prakash M. Masand, MD
8:25-8:40 a.m. Cardiac CT Dose & Pitfalls
Lorna P. Browne, MD, FRCR
8:40-8:55 a.m. Cardiac CT for Anomalous Pulmonary Venous Connections
Mark R. Ferguson, MD
8:55-9:10 a.m. Neonatal and Infantile Coronary Artery CT
Eric Hoggard, MD
9:10-9:25 a.m. Anomalous Aortic Origin of the Coronary Arteries and Myocardial Bridge Evaluation
Dianna M. E. Bardo, MD
9:25-9:40 a.m. Approach to Heterotaxy on Cardiac CT
Rajesh Krishnamurthy, MD
9:40-9:55 a.m. Cardiac CT for Ductal Dependent Anatomy
David M. Biko, MD
9:55-10:20 a.m. Wrap-up/Break
10:20-10:30 a.m. Case Review Session Introduction & Buttonology with Arterys
10:30-11:00 a.m. Independent Case Review
11:00-11:10 a.m. Mentored Case Review – Anomalous Pulmonary Venous Connections
Marielle Fortier, MD
11:10-11:20 a.m. Mentored Case Review – Coronary Arteries
Hyun Woo Goo, MD, PhD
11:20-11:30 a.m. Mentored Case Review - Heterotaxy
Maryam Ghadimi Mahani, MD
11:30-11:40 a.m. Mentored Case Review – Ductal Dependent Anatomy
Cynthia K. Rigsby, MD, FACR
11:40 a.m.-12:00 p.m. Interesting Case Review
Carlos F. Ugas Charcape, MD
8:00 AM – 12:00 PM Interventional Radiology (SAM)
Continental Ballroom 4&5
Moderator: Manish Patel, DO
8:00-8:05 a.m. Welcome, Introductions & SAM Overview
Leah E. Braswell, MD
8:05-8:30 a.m. HIFU
Karun Sharma, MD
8:30-8:55 a.m. Complex Vascular Access IJ & Beyond
Allison S. Aguado, MD
8:55-9:20 a.m. Management of Biliary Strictures
Giridhar Shivaram, MD
9:20-9:45 a.m. Discussion & SAM Questions
9:45-10:00 a.m. Break
10:00-10:05 a.m. Welcome Back & SAM Reminder
10:05-10:30 a.m. Artificial Intelligence in IR
Matthew P. Lungren, MD
10:30-10:55 a.m. Retinoblastoma Intra-arterial Chemotherapy
Todd Abruzzo, MD
10:55-11:20 a.m. Pediatric Thrombolysis with Update on Management for May-Thurner
Patrick Warren, MD
11:20 a.m.-12:00 p.m. Discussion & SAM Questions
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S68
8:00 AM – 12:00 PM Best Practices: Collaboration & Innovation for Pediatric Nuclear Medicine &
Hybrid Imaging (SAM)
Continental Ballroom 2&3
Moderators: Helen Nadel, MD, FRCPC & Victor J. Seghers, MD, PhD
8:00-8:05 a.m. Welcome, Introductions & SAM Overview
Helen Nadel, MD, FRCPC
8:05-8:30 a.m. How Nuclear Medicine is Practiced at Children’s Hospitals
Victor J. Seghers, MD, PhD
8:30-8:55 a.m. Brain PET/MRI for Epilepsy – Best Practices
Hisham Dahmoush, MBBCh
8:55-9:20 a.m. Considerations of Pediatric Nuclear Medicine Including PET/MRI
Derrick Gillan, BS, CNMT PET, RT (N)(CT)(MR)
9:20-9:45 a.m. Discussion & SAM Questions
9:45-10:00 a.m. Break
10:00-10:05 a.m. Welcome Back & SAM Reminder
Victor J. Seghers, MD, PhD
10:05-10:35 a.m. Multidisciplinary Approach to Thyroid Cancer – Two Centers’ Experience
Kara D. Meister, MD & Adina L. Alazraki, MD
10:35-11:00 a.m. Clinical Update on Liver Tumors
Arun Rangaswami, MD
11:00-11:20 a.m. Lymphoscintigraphy
Adina L. Alazraki, MD, FAAP
11:20-11:40 a.m. NAT
Sabah Servaes, MD
11:40-11:50 a.m. Discussion & SAM Questions
11:50 a.m.-12:00 p.m. Wrap-up
8:00 AM – 12:00 PM Education: Advanced Skills in Translational Teaching (SAM)
Continental Ballroom 1
8:00-8:15 a.m. Welcome, Introductions & SAM Overview
Sarah Milla, MD, FAAP
8:15-8:30 a.m. Teaching Dynamically
Sarah Milla, MD, FAAP
8:30-9:15 a.m. Technology That Works in Teaching
Janet R. Reid, MD, FRCPC
9:15-10:00 a.m. Hands-on: Two Minute PowerPoint & Panel
Sarah Milla, MD, FAAP
10:00-10:30 a.m. Break
10:30-10:45 a.m. The Complete Scope of Teaching
Janet R. Reid, MD, FRCPC
10:45-11:00 a.m. Building and Maintaining a Teaching Portfolio
Mahesh M. Thapa, MD
11:00-11:45 a.m. Hands-on: Teaching Portfolio
Sarah Milla, MD, FAAP
11:45-12:00 p.m. Discussion & SAM Questions
8:00 AM – 12:00 PM Neuroradiology (SAM)
Continental Ballroom 7&8
8:00-8:05 a.m. Welcome, Introductions & SAM Overview
8:05-8:35 a.m. Pediatric Leukodystrophies
Andrea Rossi, MD
8:35-9:05 a.m. Metabolic Disorders in Newborns
Theirry A. G. M. Huisman, MD
9:05-9:30 a.m. Pediatric Vascular Imaging in 2019
Francisco Perez, MD, PhD
9:30-9:45 a.m. Discussion & SAM Questions
9:45-10:00 a.m. Break
10:00-10:35 a.m. Imaging of Hydrocephalus
Birgit B. Ertl-Wagner, MD, MHBA
10:35-11:05 a.m. Hydrocephalus Treatment – Neurosurgery Perspective
Nalin Gupta, MD
11:05-11:35 a.m. Basics of Artificial Intelligence in Pediatric Neuroimaging
Matthias Wagner, MD
11:35 a.m.-12:00 p.m. Discussion & SAM Questions
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S69
8:00 AM – 12:00 PM Hands-On Ultrasound Golden Gate Ballroom
Moderators: Kassa Darge, MD, PhD & Monica Epelman, MD
8:00-8:45 a.m. Session I: Intravesical Contrast Enhanced Ultrasound
Presentation: Susan J. Back, MD
Station 1: Preparation of Ultrasound Contrast Agents –
Laura Poznick, RDMS & Brandi Kozak, RDMS
Station 2: Imaging of Microbubbles: A Teach Yourself Session – Lamont Hill, RT, ARDMS
& Kassa Darge, MD, PhD
Station 3: Imaging of Microbubbles: A Teach Yourself Session – Trudy Morgan, RDMS
Station 4: Simulation of Contrast Enhanced Voiding Urosonography –
Susan J. Back, MD & Elizabeth Silvestro, MSc
8:45-8:50 a.m. Break
8:50-9:20 a.m. Session II: Ultrasound Elastography
Presentation: Jonathan R. Dillman, MD, MSc
Station 1 – Jonathan R. Dillman, MD, MSc
Station 2 – Andrew S. Phelps, MD
Station 3 - Trudy Morgan, RDMS & Brandi Kozak, RDMS
Station 4 – Monica Epelman, MD & Maria G. Smith, BS, RDMS, RVT
Station 5 – Kara Groom, RDMS
9:20-9:35 a.m. Break
9:35-10:20 a.m. Session III: Ultrasound of the Appendix
Presentation: Andrew S. Phelps, MD
Station 1 – Andrew S. Phelps, MD & Janet Mar, RDMS
Station 2 – Monica Epelman, MD & Kara Groom, RDMS
Station 3 – Maria G. Smith, BS, RDMS, RVT & Stephanie Suller, RDMS
Station 4 – Lamont Hill, RT, ARDMS & Mark Goce, RDMS
Station 5 – Trudy Morgan, RDMS & Kassa Darge, MD, PhD
10:20-10:25 a.m. Break
10:25-10:55 a.m. Session IV: Ultrasound of the Knee
Presentation: Jie C. Nguyen, MD, MS
Station 1 – Jie C. Nguyen, MD, MS & Lamont Hill, RT, ARDMS
Station 2 – Trudy Morgan, RDMS & Laura Poznick, RDMS
Station 3 – Brandi Kozak, RDMS
Station 4 – Monica Epelman, MD & Kara Groom, MD
Station 5 – Mahesh M. Thapa, MD & Maria G. Smith, BS, RDMS, RVT
10:55-11:00 a.m. Break
11:00-11:30 a.m. Session V: Ultrasound of the Ankle
Presentation: Mahesh M. Thapa, MD
Station 1 – Mahesh M. Thapa, MD
Station 2 – Jie C. Nguyen, MD, MS & Lamont Hill, RT, ARDMS
Station 3 – Trudy Morgan, RDMS & Laura Poznick, RDMS
Station 4 – Monica Epelman, MD & Maria G. Smith, BS, RDMS, RVT
Station 5 – Kara Groom, RDMS & Brandi Kozak, RDMS
11:30-11:35 a.m. Break
11:35 a.m.-12:00 p.m. Session VI: Ultrasound of the Tonsils
Presentation: Anjum N. Banarkar, MD
Station 1 – Anjum N. Banarkar, MD
Station 2 – Kara Groom, RDMS
Station 3 – Maria G. Smith, BS, RDMS, RVT
Station 4 – Monica Epelman, MD & Brandi Kozak, RDMS
Station 5 – Lamont Hill, RT, ARDMS & Trudy Morgan, RDMS
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S70
SCIENTIFIC PAPERS Authors are listed in the order provided. An author listed in
bold identifies the presenting author.
Paper #: 001
Pilot study on contrast enhanced ultrasound in children post
liver transplant
Dilek Saglam, MD3, Richard S. Mangus, MS FACS2, Boaz
Karmazyn, MD1, [email protected]; 1Indiana University,
Riley Hospital for Children, Indianapolis, IN, 2Indiana
university school of medicine, Department of Surgery,
Indianapolis, IN, 3Malatya Education and Research Hospital,
Malatya, Turkey
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Assessing the added value of contrast
enhanced US in detecting the vascular complications of liver
transplantation in children.
Methods & Materials: We retrospectively evaluated all
Doppler US and contrast enhanced ultrasound (ceUS)
performed since 8/2017 when we started to routinely use ceUS.
For the first 5 post-operative days (POD) All patients had twice
a day Doppler US. ceUS was performed as a baseline in the first
POD and to confirm any suspected vascular complications.
Demographic, clinical and imaging findings were recorded and
were correlated with surgery.
Results: 14 children (9 females) had 15 liver transplants during
this period. The mean age was 4.1 years old (range 6 months-
16.1 years). Indications of the liver transplants were as follows;
biliary atresia (n=9), alpha 1 antityripsin deficiency (n=1),
metabolic liver disease (n=2), cystic fibrosis (n=1) and
cryptogenic cirrhosis (n=1). Three patients had split liver and 11
patients had whole liver transplantation.ceUS was successfully
performed in all patients. There were no complications related
to the ceUS. In three patients CEUS was performed to evaluate
for vascular complications following abnormal Doppler US. In
two patients ceUS demonstrated vascular thrombosis confirmed
in surgery: In a six month old male post whole liver transplant,
initial ceUS in POD 1, confirmed portal vein thrombosis (PVT)
seen on Doppler US. Surgery confirmed PVT but also hepatic
artery (HA) thrombosis. Marked HA narrowing in the initial
ceUS could be seen retrospectively when compared with a post
thrombectomy follow-up ceUS. In a one year old female post
whole liver transplant, initial ceUS was normal. On POD 3,
Doppler showed tardus parvus flow in intrahepatic arteries this
followed immediately by ceUS that demonstrated marked HA
stenosis. This led to seven hours follow-up ceUS that showed
progression to complete HA occlusion confirmed in surgery. In
a 16 year-old female, POD 1 ceUS excluded right hepatic vein
thrombosis suggested by Doppler and Color US.
Conclusions: Our pilot study shows that ceUS can provide
definite bed side diagnosis of vascular complications in the
immediate post liver transplant period. Use of ceUS has the
potential to provide earlier diagnosis of liver vascular
complications and obviate the need to perform contrast
enhanced CT and reduce unnecessary exploratory surgeries.
Paper #: 002
To evaluate rates of gadoxetate disodium induced transient
severe respiratory motion artifact in children
Michael H. Lanier, MD PhD, Andrew B. Wallace, Geetika
Khanna, MD, MS, [email protected]; Washington
University, Mallinckrodt Institute of Radiology, St Louis, MO
Disclosures: Geetika Khanna, MD, MS: Financial Interest:
Elsevier - Royalty: Independent contractor. All other authors
have disclosed no financial interests, arrangements or
affiliations in the context of this activity.
Purpose or Case Report: Gadoxetate disodium (Eovist ®) is
the preferred MR contrast agent for pediatric hepatobiliary
imaging. It is known to cause arterial phase transient severe
breathing motion artifacts in 5-22% of adults, and adult studies
have raised caution against its use for evaluation of arterial
enhancing lesions.This study seeks to evaluate the frequency of
transient severe respiratory motion secondary to gadoxetate
disodium in a pediatric cohort.
Methods & Materials: This is a retrospective, IRB approved
study with informed consent waiver. The radiology information
system of a children’s hospital was searched to identify all MRI
studies performed with gadoxetate disodium during January
2016- June 2018. Exclusion criterion was MRI studies with
incomplete set of dynamic post contrast imaging. Two readers
independently evaluated the pre-contrast, arterial, portal and
equilibrium phase of dynamic liver imaging for respiratory
motion artifact on a 5 point scale (1 no motion, 2 mild motion, 3
moderate motion, 4 severe motion- still diagnostic, 5 extreme
motion- not diagnostic). Average scores of the 2 readers for
each phase were used for analysis. Transient severe respiratory
motion was defined as an increase in breathing motion score of
≥ 1.5 from pre contrast to arterial phase that returned to < 3 in
equilibrium phase of imaging.
Results: The study cohort consisted of 140 cases (60% female),
age range: 1 month - 23 years (median 13 years). 102/140 scans
were performed non-sedated. 98 scans were performed on 1.5T
scanners and 42 on 3T scanners. Mean respiratory motion score
for each phase of scan for the entire cohort was: pre-contrast:
2.23, arterial: 2.56, portal venous: 2.39, equilibrium: 2.31.
Breathing motion score increased by a factor of ≥ 1.5 in 15/140
(10.71%) cases after injection of gadoxetate disodium. The
score remained at ≥ 3 in 7/15 cases, and returned to < 3 in 8
cases resulting in a transient severe respiratory motion rate of
5.71 % (8/140 cases).
Conclusions: The rate of transient severe respiratory motion
artifacts in the pediatric population is estimated at 5.7%, similar
to reported rates in the adult population. Pediatric radiologists
should be aware of this potential limitation of gadoxetate
disodium when performing hepatobiliary MRI in children.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S71
Paper #: 003
Comparison of Navigator-Gated and Breath-Held Image
Acquisition Techniques for Multi-echo Quantitative Dixon
Imaging of the Liver in Children and Young Adults
Leah A. Gilligan, MD, [email protected]; Jonathan R.
Dillman, MD. MSc, Jean A. Tkach, PhD, Andrew T.
Trout; Radiology, Cincinnati Children's Hospital Medical
Center, Cincinnati, OH
Disclosures: Jonathan R. Dillman, MD, MSc: Research
Grants: Canon Medical Systems; Siemens Healthineers;
Perspectum Diagnostics; Bracco Diagnostics, Other: Travel
Support (Philips Healthcare, GE Healthcare); Andrew T.
Trout, MD: Consultant, Honoraria: Guerbet Group, Royalty:
Elsevier, Wolters-Kluwer, Research Grants: Canon Medical,
Siemens Medical Solutions, National Pancreas Foundation, In-
Kind Support: ChiRhoClin Inc., Perspectum Diagnostics. All
other authors have disclosed no financial interests, arrangements
or affiliations in the context of this activity.
Purpose or Case Report: To compare hepatic proton density
fat fraction (PDFF), R2* values, and respiratory motion
between navigator-gated and breath-held multi-echo Dixon
(mDixon) magnetic resonance imaging (MRI) acquisition
techniques in children and young adults with suspected liver
disease.
Methods & Materials: This retrospective study was approved
by the institutional review board with a waiver of informed
consent. Patients who underwent liver MRI with breath-held
and navigator-gated mDixon sequences between January 2017
and July 2018 were included. One reviewer, blinded to
sequence, placed free-hand regions of interest, inclusive of as
much liver as possible, on four images from each PDFF and
R2* parametric map. Another blinded reviewer graded
respiratory motion using a 5-point Likert scale. Pearson
correlation (r), Lin’s concordance coefficients (rc), and Bland-
Altman analyses were used to assess agreement between
techniques. Frequency of clinically-liming motion (score≥3)
was compared with Fisher’s exact test.
Results: 42 patients were included (15F:27M; mean
age:15.7±4.6 years). Mean PDFF and R2* were 16.6±13.1%
and 29.3±4.7 sec-1 on breath-held images vs. 17.0±13.2% and
29.6±5.2 sec-1 on navigator-gated images. PDFF demonstrated
almost perfect agreement between sequences (rc=0.997,
95%CI:0.994-0.998; mean bias:0.3%; 95% limits of agreement:-
2.4 to +1.7%), while R2* values demonstrated very strong
correlation but poor agreement (r=0.837, rc=0.832,
95%CI:0.716-0.910). Navigator-gated images exhibited
significantly higher frequency of clinically-limiting respiratory
motion (88% vs. 48%, p=0.0001).
Conclusions: Despite greater respiratory motion artifact, a free-
breathing navigator-gated mDixon sequence produces PDFF
values with almost perfect agreement to a breath-held sequence
and thus may be an option in patients with limited breath-
holding capacity.
Paper #: 004
Low b-value diffusion-weighted images detect significantly
more hyperintense liver lesions in children than T2-
weighted images.
Angelo Don Grasparil, [email protected];
Hemali Solanki, Elizabeth Sheybani, Govind B. Chavhan, MD,
DABR; Hospital for Sick Children, Toronto, Ontario, Canada
Disclosures: Govind B. Chavhan, MD, DABR: Consultant,
Honoraria: Bayer, Inc. All other authors have disclosed no
financial interests, arrangements or affiliations in the context of
this activity.
Purpose or Case Report: Applying lower diffusion gradient
eliminates signal from all the vessels thereby improving
visibility of T2-hyperintense lesions on image with low b-value
of 50-100 s/mm2 (LBV). LBV have been shown to be superior
to T2-weighted fast spin echo sequence (T2W) in detection of
liver lesions in adults. There are no such studies assessing this
in children. The purpose of the study is to compare the
sensitivity of LBV images and T2W images in the detection of
focal liver lesions in children.
Methods & Materials: A retrospective review of liver MRI
performed for assessment of focal liver lesions in 50 children
(22 males, 28 females; age 2 months to 17 years (mean 10.88
years)) was done. Two radiologists reviewed both LBV and
T2W sequences independently at different occasions to note
number of lesions, smallest lesion size, and location. A
consensus reading of the entire MRI examination and
correlation with follow-up, other imaging modalities, and
pathology in available cases, was used to determine final
number of lesions as a reference standard. Inter-observer
agreement between 2 sequences for each reader for detection of
number of lesions was assessed using intra-class correlation
coefficient (ICC). The average number of lesions per patient
detected by both readers on each sequence was compared with
each other and with the reference standard using ICC and
Signed-Rank test. The smallest lesions detected by each
sequence were compared using paired t-test.
Results: A total of 170 hyperintense lesions were identified on
consensus review to serve as reference standard. The average
number of lesions identified by both readers on LBV was 134
(79%) and on T2W were 95 (56%). There was excellent inter-
observer agreement for detection of lesions on LBV (ICC=0.96
(0.93-0.98)) and T2W (ICC=0.85 (0.75-0.91)), with slightly
better agreement on LBV. Both readers identified significantly
more lesions on LBV compared to T2W (reader 1 p=0.0036,
reader 2 p=0.0001). Compared to the reference standard (mean
number of lesions=3.45), T2W detected significantly less
lesions (mean number of lesions=1.91; p=0.0000) while there
was no significant difference in lesion detection on LBV (mean
number of lesions-2.68; p=0.1527). LBV and T2W were not
significantly different in identifying the smallest lesion size
(reader 1 p=0.50, reader 2 p=0.53).
Conclusions: Low b-value DWI images are more sensitive than
T2-weighted sequences in detecting hyperintense focal liver
lesions in children.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S72
Paper #: 005
Normal Pancreatic Parenchymal Volume in Heathy
Children
Brendan McCleary, MD1, [email protected]; Andrew T.
Trout1, Maisam Abu-El-Haija, MD1, Lin Fei, PhD1, Qin Sun,
MPH1, Suraj Serai2, Jonathan R. Dillman, MD. MSc1; 1Radiology, Cincinnati Children's Hospital Medical Center,
Cincinnati, OH, 2Children's Hospital of Philadelphia,
Philadelphia, PA
Disclosures: Andrew T. Trout, MD: Consultant, Honoraria:
Guerbet Group, Royalty: Elsevier, Wolters-Kluwer, Research
Grants: Canon Medical, Siemens Medical Solutions, National
Pancreas Foundation, In-Kind Support: ChiRhoClin Inc.,
Perspectum Diagnostics; Jonathan R. Dillman, MD, MSc:
Research Grants: Canon Medical Systems; Siemens
Healthineers; Perspectum Diagnostics; Bracco Diagnostics,
Other: Travel Support (Philips Healthcare, GE Healthcare). All
other authors have disclosed no financial interests, arrangements
or affiliations in the context of this activity.
Purpose or Case Report: Pancreatic atrophy, a finding of
chronic pancreatitis, has traditionally been defined qualitatively.
Volumetric measurements of the pancreas may provide a means
to define atrophy more quantitatively but an understanding of
normal volume is required. The purpose of this study was to
define normal pancreatic parenchymal volume in children, its
relationship with demographic and anthropometric factors and
its relationship to volume of fluid secreted after secretin
administration.
Methods & Materials: This study was IRB-approved and
compliant with HIPAA. A single observer manually segmented
(Vitrea, Vital Images) the pancreas on axial MR images
prospectively obtained in 50 children (6-16 years) without
pancreatic disease. Parenchymal volumes were correlated
(Pearson) with age, height, weight, body surface area (BSA) and
with previously calculated volume of fluid secreted in response
to secretin. Student’s t-test was used to compare means.
Quantile regression was used to define 5th/95th percentiles for
parenchymal volume by BSA.
Results: Mean (±SD) parenchymal volume for our 50 healthy
children was 46.0±18.8mL. There was no significant difference
in parenchymal volume by sex. There were statistically
significant correlations between parenchymal volume and age (r
= 0.51, p=0.002), height (r=0.67, p<_0.0001), weight (r=0.75,
p<0.0001) and BSA (r=0.75, p<0.0001). The 5th percentile for
parenchymal volume by BSA could be calculated by: = -
4.97+24.66xBSA.Parenchymal volume was statistically
significantly correlated with secreted fluid volume in response
to secretin (r=0.51, p=0.0002).
Conclusions: In this study we have defined normal pancreatic
volumes for children, and shown that these values vary with
patient age and size. We have also defined the 5th percentile for
parenchymal volume by BSA, below which atrophy might be
considered to be present as a feature of chronic pancreatitis. We
have also shown that pancreatic parenchymal volume was
moderately correlated with volume of fluid secreted by the
pancreas in response to secretin.
Paper #: 006
Assessment of Normative Cut-offs for Pancreas Thickness
and T1 Signal Ratios in the Pediatric Pancreas
Brendan McCleary, MD, [email protected]; Andrew T.
Trout, Jonathan R. Dillman, MD. MSc, Maisam Abu-El-Haija,
MD; Radiology, Cincinnati Children's Hospital Medical Center,
Cincinnati, OH
Disclosures: Andrew T. Trout, MD: Consultant, Honoraria:
Guerbet Group, Royalty: Elsevier, Wolters-Kluwer, Research
Grants: Canon Medical, Siemens Medical Solutions, National
Pancreas Foundation, In-Kind Support: ChiRhoClin Inc.,
Perspectum Diagnostics; Jonathan R. Dillman, MD, MSc:
Research Grants: Canon Medical Systems; Siemens
Healthineers; Perspectum Diagnostics; Bracco Diagnostics,
Other: Travel Support (Philips Healthcare, GE Healthcare). All
other authors have disclosed no financial interests, arrangements
or affiliations in the context of this activity.
Purpose or Case Report: Normal values for linear thickness of
the pancreas in children have recently been established on CT,
but have not been validated for MRI. Additionally, a normal T1
ratio (pancreas:spleen) has been defined in adults but this has
not been validated in children. The purposes of this study were:
1) To validate previously defined normal pancreatic thickness
measurements for MRI and in a distinct pediatric population. 2)
To validate the previously defined T1 ratio (pancreas:spleen) for
adults in a pediatric population and assess its relationship to
demographic factors.
Methods & Materials: This study was IRB approved and
HIPAA compliant. A single observer measured linear thickness
of the pancreas in the four previously defined segments (head,
neck, body and tail) on axial images from 50 MRI exams
prospectively obtained in children (6-16 years old) without
pancreatic disease. ROIs were also placed in each the pancreas
and spleen (on the same slice, if possible) on T1-weighted
gradient recalled echo (GRE) images to measure the T1 ratio.
Linear measurements were compared to previously defined
norms. T1 ratios were summarized with means and standard
deviations and assessed for their relationship to age, sex, height,
weight and body surface area (BSA) using t-tests and linear
regression, as appropriate.
Results: Using previously defined normal values for pediatric
pancreatic thickness, 34 healthy participants (68%) had
“atrophy” of one segment and 14 (28%) had “atrophy” of two or
more segments.Mean (±SD) T1 ratio for the study population
was 1.33±0.15. There was a statistically significant correlation
between T1 ratio and age and height (r=-0.44, p=0.0015 and r=-
0.38, p=0.0069, respectively). but not with weight or BSA.
There was no significant difference in T1 ratio based on sex. 11
participants (22.4%) had a T1 signal ratio <1.2, a threshold
previously determined to correspond with exocrine
insufficiency in an adult population.
Conclusions: We demonstrate that previously defined normal
pancreas thickness values for children are likely too restrictive
and that better measures of pancreas bulk in children are
needed. Mean T1 ratio in children is related to age and height
and is above the normal threshold of 1.2 previously described in
adults but >20% of children have T1 ratios below the adult cut-
off suggestive of exocrine insufficiency. Specific cut-offs for
disease identification by T1 ratio in children are needed.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S73
Paper #: 007
Magnetic Resonance Imaging T1 Relaxation Times for the
Liver, Pancreas, and Spleen in Healthy Children at 1.5 and
3T
Leah A. Gilligan, MD, [email protected]; Jonathan R.
Dillman, MD. MSc, Jean A. Tkach, PhD, Stavra A. Xanthakos,
MD, MS, Jacqueline K. Gill, MPA, Andrew T. Trout;
Radiology, Cincinnati Children's Hospital Medical Center,
Cincinnati, OH
Disclosures: Jonathan R. Dillman, MD, MSc: Research
Grants: Canon Medical Systems; Siemens Healthineers;
Perspectum Diagnostics; Bracco Diagnostics, Other: Travel
Support (Philips Healthcare, GE Healthcare). Andrew T.
Trout, MD: Consultant, Honoraria: Guerbet Group, Royalty:
Elsevier, Wolters-Kluwer, Research Grants: Canon Medical,
Siemens Medical Solutions, National Pancreas Foundation, In-
Kind Support: ChiRhoClin Inc., Perspectum Diagnostics. All
other authors have disclosed no financial interests, arrangements
or affiliations in the context of this activity.
Purpose or Case Report: Magnetic resonance imaging (MRI)
T1 relaxation time is altered by fibrosis and inflammation and is
a potential marker for diseases of the solid abdominal organs.
The purpose of this study was to measure T1 values of the liver,
pancreas, and spleen in healthy children.
Methods & Materials: This cross-sectional IRB-approved
study prospectively recruited healthy children aged 7 to 17 years
with BMI in the 5th to 85th percentile to undergo abdominal MRI
at 1.5 or 3T, including T1 mapping with a variant Modified
Look-Locker (MOLLI) sequence between February 2018 and
August 2018. A single reviewer placed free-hand regions of
interest on the T1 parametric maps in the liver, pancreas, and
spleen, inclusive of as much parenchyma as possible and on up
to four axial images per organ. Student t-tests were used to
identify differences in T1 values by gender. Linear regression
was performed to assess associations between T1 values and
age.
Results: 32 patients were included in the study (16F:16M; mean
age:12.2±3.1 years; n=16 at 1.5T; n=16 at 3T). Median T1
relaxation times per organ at 1.5T were: 1) liver: 569±39 ms; 2)
pancreas: 576±55 ms; and 3) spleen: 1172±71 ms and at 3T
were 1) liver: 767±63 ms; 2) pancreas: 730±30 ms; and 3)
spleen: 1356±87 ms. T1 values were not significantly different
between males and females at either field strength. Linear
regression showed no significant association between age and
T1 values of the liver, pancreas, and spleen at 1.5T (r=0.66,
p=0.30; r=0.48, p=0.094; and r=0.49, p=0.057; respectively)
and 3T (r=0.50, p=0.12; r=0.56, p=0.15; and r=0.40, p=0.12;
respectively).
Conclusions: We report normal MRI T1 values for the liver,
pancreas, and spleen at 1.5 and 3T in a cohort of healthy
children and observed no significant association between age or
sex and T1 values. While these values might be used to exclude
disease, a larger cohort will likely be needed to establish cut-off
values to allow future comparisons with disease states.
Paper #: 008
Development of MRI-compatible Robots for MRI-Guided
Procedures in Pediatric Interventional Radiology
Karun Sharma, MD, Ph.D1, [email protected]; Dan
Stoianovici, PhD2, Reza Monfaredi1, Bhupender, Yadav1
Ranjith, Vellody1, Kevin Cleary, PhD1; 1Radiology, Childrens
National Medical Center, McLean, VA, 2Johns Hopkins
Medical Center, Baltimore, MD
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Percutaneous needle placement relies
on image guidance using X-ray, CT, US, or MRI. MRI-guided
interventions are ideal for pediatric patients to eliminate
ionizing radiation while providing superior imaging of the
nervous and musculoskeletal systems. However, performing
procedures within a closed-bore MRI scanner is challenging
because of the ergonomics of limited patient access. We are
developing small, MRI-compatible robotic systems that will
enable MRI-guided interventions.
Methods & Materials: Three systems are being developed for
bone biopsy, arthrography, and nerve block/ablation. For bone
biopsy, a table-mounted robot with bone drill guide was
developed and tested in a cadaveric leg to evaluate feasibility
and accuracy. For arthrography, a patient-mounted four degree
of freedom robotic positioning and orienting stage was
developed and tested in cadaveric shoulder and hip joints. For
nerve block/ablation, a two degree of freedom needle driving
and rotation stage will allow remote needle advancement under
real-time MRI guidance. A software interface allows the
physician to select the target and skin entry point which define
the safest needle trajectory.
Results: The bone biopsy robot study shows feasibility and
clinically acceptable bone drill accuracy in a cadaver leg (Figure
1). A total of 10 biopsy targets were sampled using MRI
guidance, 5 from the femur and 5 from the tibia. All of the
targets were successfully reached with an average targeting
accuracy of 1.43 mm. The arthrography robot study in Thiel
embalmed cadavers shows feasibility and good success for
intra-articular injection during MR arthrography (Figure 2). In
one male and one female cadaver, a total of 13 robotically-
targeted joint injections were performed (10 shoulder, 3 hip).
All were successful with an average procedure time of 20
minutes. The next step is a pilot clinical trial.
Conclusions: The robotic devices presented here are being
developed to enable radiation-free MRI-guided procedures.
Clinical application in bone biopsy of suspicious lesions, joint
injection for MR arthrography, and nerve block/ablation for
pain management are pertinent to pediatric patients. The patient-
mounted design minimizes challenges of patient motion and
MR-compatibility allows safe use in the scanner bore without
degradation of image quality. These devices have the potential
to enable physicians to perform MR interventions with high
accuracy and safety and also shorten procedure duration.
Paper #: 009
Sclerotherapy of Aneurysmal Bone Cysts: MRI Imaging
Findings and Clinical Outcomes
Kimberly Dao, MD, [email protected]; Patrick
Johnston, MMath, Msc, Raja Shaikh, MBBS, MD; Boston
Children's Hospital, Boston, MA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S74
Purpose or Case Report: To investigate the long-term MRI
imaging findings and clinical outcomes of pediatric patients
with aneurysmal bone cysts treated by sclerotherapy at a large
tertiary children’s hospital.
Methods & Materials: An IRB-approved retrospective review
was performed on patients who completed sclerotherapy for
aneurysmal bone cyst from 2007 through 2018. Patients were
excluded if they had no pre-treatment MRI, post-treatment MRI,
or received surgery between sclerotherapy treatments, yielding a
total number of 38 patients. Pre-treatment and final post-
treatment MRI imaging and reports were reviewed. The
sclerotherapy treatment(s) and surgical history were recorded.
Electronic medical records were also reviewed for clinical
symptoms prior to initial presentation and preceding the final
MRI study. The data analysis for this study was generated using
SAS software.
Results: Pre-treatment MRI and biopsy results confirmed the
presence of aneurysmal bone cysts. 95% (36/38) of patients had
lesions showing fluid-fluid levels on pre-treatment MRI (95%
confidence interval (CI) 0.84-0.99). All subjects (38/38) had
lesions that were thin-walled, sclerotic rimmed, expansile
locular, and showed internal hyperintense T2 signal (CI 0.94-
0.99 for all 4 variables).The mean number of sclerotherapy
treatments was 3.6, the mean time between the last
sclerotherapy treatment and the final MRI was 158 days, and the
average interval between sclerotherapy treatments was 118
days. The mean total follow-up time was 438 days.On post-
treatment MRI imaging, 74% (28/38) showed a decreased
number of cystic spaces (CI 0.58-0.86); 68% (26/38)
demonstrated cortical thickening (CI 0.53-0.81); 84% (32/38)
showed decreased fluid-fluid levels (CI 0.7-0.93); 87% (33/38)
had decreased internal T2 signal (CI 0.74-0.95); and 89%
(34/38) showed remodeling deformity (CI 0.77-0.96).Prior to
treatment, 94% (33/35) of the patients reported pain (CI 0.84-
0.99), while by the final MRI, only 17% (6/35) of the patients
reported pain. The difference was -77 percentage points
(p<0.001). Data for 3 patients was not available regarding pain.
9/38 patients went on to receive additional surgery after
sclerotherapy.
Conclusions: There is little information about the evolution of
MRI imaging findings following successful sclerotherapy of
aneurysmal bone cysts. This study provides a summary of
common MRI findings in aneurysmal bone cysts and clinical
outcomes for these patients after sclerotherapy.
Paper #: 010
Long-term Results and Durability of Cryoablation of
Osteoid Osteoma in the Pediatric and Adolescent
Population
Jay Shah, MD, [email protected]; Anne
Gill, MD, Jennifer Laporte, Morgan Whitmore, Frederic
Bertino, MD, John David Prologo, Kelley W. Marshall, MD,
Jorge Fabregas, Nickolas Reimer, C. Matthew Hawkins, MD;
Interventional Radiology / Pediatric Radiology, Emory
University Hospital / Children's Hospital of Atlanta, Atlanta,
GA
Disclosures: John David Prologo, MD: Consultant, Honoraria:
Galil, Research Grants: Galil, Endocare. All other authors have
disclosed no financial interests, arrangements or affiliations in
the context of this activity.
Purpose or Case Report: To confirm technical feasibility and
clinical efficacy of osteoid osteoma (OO) cryoablation in a
large, pediatric/adolescent cohort with short and long term
follow-up.
Methods & Materials: An electronic medical record and
imaging archive review was performed to identify all
cryoablations performed for OOs between 2011 and 2018 at a
single tertiary care pediatric hospital. The analysis included 63
patients with suspected OOs treated by cryoablation (age range,
3-18 y; mean age, 11.7 y; 37 boys; 26 girls). Conventional CT
guidance was used in 22 procedures; cone-beam CT needle
guidance was used in the remaining procedures. Follow-up data
were obtained via a standardized telephone questionnaire and
clinical notes.
Results: Technical success, defined as placement of cryoprobes
in the desired location, was achieved in 100% of the 63
patients.Immediate clinical success (cessation of pain and
nonsteroidal antiinflammatory drug [NSAID] use within 1 mo
after the procedure) was achieved in 61/63 (96.8%) of patients.
There were 2/63 (3.2%) clinical failures, both in small bones of
the feet. 5/63 (7.9%) patients had clinical recurrence with repeat
ablation and subsequent complete response. Furthermore, long-
term clinical success (cessation of pain and NSAID use for > 12
mo after the procedure) was achieved in 54/57 patients (94.7%)
at the time of this submission. There were no major
complications. Two patients (3.2%) were admitted overnight for
pain control after the procedure (minor complications). There
were no other minor complications.
Conclusions: Image-guided cryoablation is a known technically
feasible, clinically efficacious, and safe therapeutic option for
children and adolescents with symptomatic OO. Long-term
results in this study provide confirmation of a definitive
treatment paradigm.
Paper #: 011
Image-guided biopsy for suspected pediatric osteomyelitis:
analysis of experience
Neil K. Jain, [email protected]; Sulman Mahmood, Victor
Ho-Fung, MD, James Edgar, Sphoorti Shellikeri, Master's in
Biomedical Engineering, Anne Marie Cahill, Ganesh
Krishnamurthy, MD, Abhay Srinivasan, MD; Pediatric
Interventional Radiology, Children's Hospital of Philadelphia,
Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Biopsy is often performed to aid in
diagnosis and to clarify optimum management of children with
suspected osteomyelitis. We describe our experience with bone
biopsy for pediatric osteomyelitis and analyze yield with regard
to imaging features on MRI and procedure technique.
Methods & Materials: This was a retrospective review of
patients with suspected osteomyelitis who underwent
percutaneous bone biopsy in interventional radiology. Review
parameters included MRI features, technical aspects of the
procedure, and clinical data, including details of clinical
presentation and microbiology and pathology results.
Results: Forty patients (mean age 9.5y, range 0.4-25.8y)
underwent biopsy. Fluoroscopy was used in 29 cases. CT
guidance was used in 9 and US guidance was used in 2.
Additional US guidance for adjacent soft tissue biopsy was used
in 15 cases. A 16G bone biopsy cannula was utilized in 34
cases; 13G in 5; and an 11G in 1 case. The mean number of
bone cores obtained was 3.6 (range 1-10). There were no
procedure-related complications.Biopsy culture yielded a
pathogen in 4 of 40 cases, and culture yield did not show
significant correlation with fever, leukocytosis/blood culture,
ESR/CRP, number of cores, instrument gauge, or acquisition of
liquid aspirate or soft tissue. Based on culture and/or pathology
results, 23 patients were diagnosed with infectious osteomyelitis
(17 acute and 6 chronic). One patient was diagnosed with a
stress fracture and one with Hodgkin lymphoma. Chronic
recurrent multifocal osteomyelitis (CRMO) was diagnosed in 15
patients; CRMO was supported on pathology in 9 cases. Biopsy
results, therefore, did not directly inform diagnosis in 6 (15%)
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S75
patients.On MRI, 74% of lesions were in the appendicular
skeleton and 26% in the axial skeleton. An axial location
demonstrated a significant association with a positive bacterial
culture (p=0.04). There was also a statistically significant
association between a lesion size ≤20 mm on MRI and negative
bacterial culture (p<0.01). There was no association between
culture yield with interosseous/subperiosteal fluid or myositis.
Conclusions: Results support bone biopsy as a safe and
effective procedure in the management of pediatric
osteomyelitis. Although culture yield from bone biopsy was
low, overall biopsy results aided in diagnosis in a majority
(85%) of patients with suspected osteomyelitis. On MRI, lesion
size ≥20 mm and an axial location demonstrated association
with positive culture.
Paper #: 012
Ultrasound-Guided Synovial Biopsy in Children
Paymun Pezeshkpour, B.Sc.,
[email protected];Catherine
Chung, Shirley Tse, Afsaneh Amirabadi, Simal Goman,
Michael Temple; Hospital for Sick Children, Toronto, Ontario,
Canada
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To determine technical success,
complication and diagnostic rates of ultrasound-guided synovial
biopsy (USGSB) in pediatric patients at a pediatric tertiary
referral center.
Methods & Materials: This retrospective single center study
was approved by the research ethics board and included all
patients who underwent USGSB at a tertiary referral center.
Patients were identified using the GE Centricity Picture
Archiving and Communication System (PACS), the
Interventional Radiology EST-IGT database and Surgical
Information Systems software (SIS). Patient demographics,
clinical information (history and physical exam), clinical
investigations including pathology reports, procedure details
and complications were collected. A Microsoft Excel 2016
database was used to compile data for descriptive analysis. All
statistical analyses were performed by SPSS.
Results: Between May 2000 to March 2017, 22 patients
(4M:18F) underwent 25 USGSBs. Median age was 11 years
(range 1.6–17) & median weight was 40.2 kg (range 10–83).
Presenting symptoms were pain, mobility issues and joint
effusion (n=15, 10, 9 respectively) with use of analgesics (14/22
patients), antibiotics (1/22) & immune modulators (2/22).
Synovial thickening ranged between 1.5–15mm with a mean of
5mm. 21/25 biopsies had effusion measured and it was detected
in 12/21. 18/25 biopsies measured doppler signal and 7/18 were
subjectively increased. A total of 105 passes (median 4, range 2-
8) yielded 95 cores (median 4; range, 1-8). All procedures were
technically successful. 8/25 samples did not contain synovium
((5/8 were referred by orthopedics, 3/8 from rheumatology,
p=0.06); 1/8 diagnosis of underlying reparative process made).
Based on multivariable logistic regression analysis, the number
of cores/passes, ultrasound probe type and biopsy orientation
did not predict the absence of synovium. Only 1 patient with a
non-diagnostic biopsy underwent subsequent surgical biopsy. In
the remaining 17, pathology showed no pathological
abnormality (n=2), synovitis (n=6), reparative changes (n=5),
neoplastic process (n=2) & other (n=3; 1 lymphoplasma
synovitis, 1 necrotic bone and 1 hemosiderin-laden macrophage
infiltration). 3 mild procedure related adverse events considered
rarely preventable.
Conclusions: USGSB is a technically feasible and safe
procedure in the diagnosis of synovial thickening of unknown
etiology or with inconclusive aspiration results and/or serologic
findings. A trend towards nondiagnostic samples was found in
orthopedic patients.
Paper #: 013
Complex Cystic Thyroid Nodule Fine Needle Biopsies in
Children – Experience in a Tertiary Pediatric Center
Fernando Escobar, MD, [email protected]; Madiha
Aslam, MBBS, Abhay Srinivasan, MD, Anne Marie Cahill; The
Children's Hospital of Philadelphia, Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Complex cystic lesions of the thyroid
can be challenging to biopsy even with fine needle technique
especially if intralesional hemorrhage during biopsy partially
obscures the lesion.The purpose of this study is to review our
experience with fine needle biopsy of complex cystic and
simple cystic thyroid nodules in children and assess the rate of
intralesional hemorrhage.
Methods & Materials: An IRB approved database of patients
who underwent ultrasound guided fine needle biopsies for
simple cystic and complex cystic thyroid nodules was queried
for diagnostic accuracy. Correlation of intra-lesional
hemorrhage with risk factors such as age, size and vascularity of
nodule, needle gauge and number of passes.
Results: One hundred and seven patients with 196 thyroid
nodules US guided fine needle aspiration biopsy procedures, (85
F, 22M), mean age 15.4 yrs. (7-25yrs). Nodules were as
follows; 169/196 (86%) complex cystic and 27/196 (14%) were
simple cystic. Technical success was 195/196 (99%) one
procedure aborted due to patient discomfort. Needle gauge was;
27g in 120/195 nodules, 25g in 67/195 and both in 9/195
nodules. Number of passes were as follows; 2 passes in 9/195
nodules, 3 in 139/195, 4 in 41/195, 5 in 4/195, 6 in 1/195, 8 in
1/195 nodules. Intralesional hemorrhage was seen in 84/195
nodules (43%); of those 60/84 (71%) were complex cystic
nodules, 24/84 (29%) were simple cystic nodules. Number of
passes in these nodules were; 3 passes in 61/84 nodules, 4
passes in 18/84, 5 passes in 5/84 nodules. Diagnosis was
achieved in 189/195 nodules (97%). Histological diagnoses
were as follows; benign hyperplastic focus in nodular goiter in
157/195 nodules, follicular lesion of undetermined significance
in 11/195, papillary thyroid carcinoma 9/195, follicular
neoplasm 7/195, atypia of undetermined significance 4/195,
benign squamous cyst in 1/195 and unsatisfactory specimen in
6/195 nodules. The intralesional hemorrhage rate was 89 %
(24/27) for simple cystic lesions and 36% (60/169) for complex
cystic nodules. Pathological surgical correlation was available
in 51/107 patients (48%) and 5/51 (10%) patients had a
divergent malignant diagnosis from FNA biopsy with papillary
microcarcinoma diagnosed on surgical pathology.
Conclusions: In our experience the diagnostic yield for FNA of
complex and simple cystic lesions of the thyroid (97%) was
very high compared to other published studies with the number
of unsatisfactory diagnoses too low to correlate with lesion or
biopsy technique characteristics.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S76
Paper #: 014
Novel Approach to Increase Technical Success during
Pediatric Percutaneous Gastrostomy/Gastrojejunostomy
Tube Placement using Transgastric Balloon Occlusion
Rachelle Durand, DO, [email protected]; Sphoorti
Shellikeri, Master's in Biomedical Engineering, Anne Marie
Cahill, Michael Acord, MD; Radiology, Children's Hospital of
Philadelphia, Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Adequate gastric distension via
insufflation is a key step in creating a safe percutaneous window
during gastrostomy/gastrojejunostomy (G/GJ) placement.
However, this may be limited due to rapid egress of air from the
stomach into the duodenum, despite the use of glucagon.
Herein, we describe an adjunctive novel technique of
transgastric balloon occlusion to maximize gastric insufflation
and assess the outcome of this technique during G/GJ placement
in children.
Methods & Materials: A single-center, IRB-approved,
retrospective review of 15 patients (6 female and 10 males) with
a mean age of 4.8±5.6 years (range 0-16 years) and mean
weight of 20.9±18.9 kg (range 3-54.2 kg) who had G/GJ
placement utilizing transgastric balloon occlusion over a 2 year
period. The standard technique was antegrade placement with
administration of glucagon. After initial percutaneous failure,
more recently the practice of positioning a balloon in the
proximal duodenum was adopted to temporarily obstruct the
gastric outlet. Clinical history, patient demographics, procedure
reports, balloon type, technical success, and outcomes were
reviewed.
Results: The addition of a transgastric balloon occlusion was
successful in salvaging G/GJ tube placement in 10/15 (67%)
patients (3 G, 7 GJ) which likely would have been unsuccessful
using standard practice. Most common underlying disorders
included cardiac (5), neurologic (3), and oncologic (2). Of 5
unsuccessful placements, 3 were attributed to persistent colonic
interposition/high position, 2 to high stomach position.
Subsequently, 4 of 5 underwent surgical gastrostomy placement.
No procedure-related complications were reported.
Conclusions: The technical success of G/GJ placement in
children with challenging percutaneous access may be improved
by the novel use of transgastric balloon occlusion to prevent
rapid egress of air out of the stomach. A larger cohort is needed
to assess the technical efficacy and to identify ideal balloon
characteristics and insufflation location based on patient and
disease characteristics.
Paper #: 015
Bridging the Barriers for Better Team-Based Patient Care
by Incorporating NICU Radiology Tele-rounds
Susan E. Schmidt, MD, Joseph Cao, Kate Louise M. Mangona,
MD, Thomas O'Neill, Jeannie Kwon, [email protected];
UTSW, Lucas, TX
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Pediatric radiologists have provided
valuable daily on-site consultation for two separate neonatal
intensive care units (NICU), located at the university hospital
(UH) and the public county hospital. This historically required
travel to three separate physical locations throughout the day.
Additional challenges to the workflow included the addition of a
third location for daily consultation rounds at the children's
hospital NICU and the elimination of a campus shuttle route.
While the pediatric radiology department's goal was to maintain
the high level of service, availability, and communication with
the neonatology team, concerns regarding time and movement
energy waste due to travel threatened to make this untenable.
Methods & Materials: A reliable process for conducting
patient care rounds with participants physically located in
different institutions across the medical campus was established
using a web-based teleconferencing tool. Requirements of the
application were that connectivity should be (nearly)
instantaneous across the networks of three different hospitals,
reliable, and user-friendly, with two-way audio and video,
including screen sharing to facility discussion of interesting
radiology findings. Schedule, daily electronic meeting
apointments were sent to the assigned pediatric radiologist and
the NICU conference room at the UH, where clinical team
rounds occurred over a two-hour period daily. On-site rounds
were preserved at the two larger NICUs which were also in
closer proximity to one another.
Results: Travel times were significantly reduced following
implementation of remote consultation at the UH NICU facility,
with an estimated savings of 4940 minutes, 113.1 miles, and
225,420 steps over a six month timeframe. Feedback from
pediatric radiology faculty and NICU treatment teams was
widely positive following the implementation of telerounds. We
demonstrated the ability to provide a similar level of quality of
communication, ability to entertain dialogue regarding exams,
and timeliness of rounds and a significant increase in
satisfaction after implementation across all metrics.
Conclusions: The implementation of tele-radiology NICU
rounds resulted in savings in time and travel and improved
satisfaction with communication for both radiology and NICU
providers.
Paper #: 016
Implementing the “What-Where-When” approach to
improve patient history availability at the time of
radiograph interpretation
Aaron S. McAllister, MD, Courtney M. Kirby, MBA,
[email protected]; Julee Eing, RT, Erin
L. Mesi, RT(R), Phillip McGonagill, LSSBB, Benjamin
Thompson, DO, Nicholas A. Zumberge, MD, Rajesh
Krishnamurthy; Nationwide Children's Hospital, Columbus,
OH
Disclosures: Aaron S. McAllister, MD: Equity Interest/Stock
Option: GE, MMM, CHD, JNJ. All other authors have disclosed
no financial interests, arrangements or affiliations in the context
of this activity.
Purpose or Case Report: Nonexistent/incomplete clinical
information at the time of radiographic exam is an impediment
to efficient and accurate radiological interpretations. We aim to
improve the relevant information at point of care interpretation
for radiologists. Technologists were utilized to gather relevant
clinical information at the point of care to supplement the
available clinical information utilizing a previously described
“What-Where-When” approach (Hawkins et al., 2013).
Methods & Materials: Histories were considered complete
when they contained all of the following 3 elements: what
(reason for the study, mechanism of injury, etc.,) where
(location - lateral, diffuse, etc.,) and when (element of time:
acute, chronic, etc.) A baseline measure was obtained by
evaluating a random sampling (n=213) of histories
accompanying radiographs by awarding 1 point for each
element present in the history (max =3) acquired via the
hospital’s EMR in April 2018.Subsequently, technologists were
asked to fill in missing data elements from the ordering
provider’s clinical history at point of care. Clinical histories
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S77
were rescored in October 2018 (n=232), this time including the
supplemental history acquired by the technologist. Balance
measures were considered by sampling 100 exams to verify the
accuracy of the technologist supplemented clinical histories and
additional analysis was conducted to measure any negative
effect on exam turnaround time. Additionally, a technologist
survey assessed participation and ideas for improvement. A
radiologist survey assessed perceived usefulness of the available
history before and after technologist augmentation as well as
impact on diagnostic confidence, accuracy, and efficiency.
Results: Exams with complete patient histories increased from
22% to 56%. The exam history, on average, saw an increase in
elements present. The accuracy of the supplemented exam
history was 97%. There was no increase in technologist
turnaround time following the addition of this task.
Radiologist’s rated impact of the completed histories on their
imaging interpretation using a scale of 1-5 (low-high):
interpretation efficiency: 5.0, accuracy: 5.0, frequency of use:
4.3, altered search pattern or thought process: 3.7.
Conclusions: Radiograph technologists have proven capable
and successful at gathering the what, when, and where at point
of care with no significant negative impact. This targeted
clinical information collected by x-ray technologist’s results in
improved diagnostic confidence, efficiency, and accuracy.
Paper #: 017
Effect of a Double-Interpretation Skeletal Survey Program
on Child Abuse Evaluations
M Katherine Henry, MD, MSCE, Ammie M. White, MD,
[email protected]; Sabah Servaes, Andrew J. Degnan,
MD, MPhil, Michael L. Francavilla, MD, Victor Ho-Fung,
MD, Ann Johnson, Summer Kaplan, MD MS, Richard
Markowitz, Hansel J. Otero, MD, David Saul, Lisa States,
Raymond Sze, Joanne Wood, Philip Scribano; Children's
Hospital of Philadelphia, Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Child protection teams (CPTs) rely
on skeletal surveys (SS) to identify young children with occult
fractures who may be victims of abuse. Little is known about
the utility of double interpretation SS programs. The goals of
this project are to (1) quantify disagreement between
radiologists regarding fractures and (2) evaluate whether second
interpretations alter management of children undergoing
evaluation for abuse.
Methods & Materials: Our institution’s CPT and Department
of Radiology established a quality improvement collaboration to
pilot a double interpretation SS program. During this ongoing
pilot, SSs are first interpreted by pediatric radiologists, and
later, CPT requests a second interpretation from a core group of
second readers, with an option to ask a question for
clarification. The second radiologist documents whether the
second interpretation: (a) has a different interpretation regarding
fracture presence, absence, or certainty (b) a different
interpretation regarding another aspect of the SS, (c) whether
additional views or modalities were reviewed, and then (d)
answers CPT’s question. CPT reviews the second reader’s
responses and determines: (e) whether the second read process
changed concern for abuse; (f) whether medical management
changed; and, (g) degree (Likert scale) to which this process
was helpful in increasing confidence in SS interpretation.
Results: To date, 129 SS double interpretations were
completed, 93 (72.1%) initial and 36 (27.9%) follow up. Median
age was 7.2 months; 58.9% were male. The proportion of
second reads with a different interpretation (disagreement)
regarding fracture presence, absence, or certainty was 7.0%
(95% CI 3.6, 12.9; N=9). As a result of the second read process,
CPT concern for abuse changed in 8 cases (6.2%; 95% CI
3.1,12.0), increased in 5 and decreased in 3. After consideration
of the constellation of clinical findings, CPT concern rarely
changed from abuse to non-abuse (N=1) or from non-abuse to
abuse (N=1). CPT medical management changed in 11.6%
(95% CI 7.1, 18.5). CPT reported that the second read process
was helpful in increasing confidence in SS interpretation in over
90% of cases.
Conclusions: Our pilot identified agreement in fracture
presence, absence, or certainty in >90% of cases. The second
read process resulted in a change in the level of concern for
abuse in <10% of cases. Additional data are needed to
understand if certain SS findings are at higher risk for
disagreement to understand the utility of targeted second read
programs.
Paper #: 018
Effectiveness of showing an interactive animated video vs
regular animated video in improving children’s
cooperativeness during MRI scan: a prospective,
randomized, non-inferiority trial
Evelyn Gabriela Utama, Doctor of Medicine (MD
Candidate)1 [email protected]; Seyed Ehsan Saffari,
PhD2, Phua Hwee Tang, FRCR3; 1Duke-NUS Medical School ,
Singapore, Singapore, 2Duke-NUS Medical School, Centre for
Quantitative Medicine, Singapore, Singapore, 3Department of
Diagnostic & Interventional Imaging, KK Women's and
Children's Hospital, Singapore, Singapore
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Magnetic resonance imaging (MRI)
can cause considerable anxiety in children due to the unfamiliar
environment, loud noises, confined space, and the need to lie
still. They can become un-cooperative and move during the
scan, resulting in non-diagnostic images due to motion artefacts.
We previously reported in a prospective, randomized controlled
trial that animated educational videos shown to children before
their MRI scan reduced the percentage of children needing
repeated MRI sequences and improved children’s confidence of
staying still for at least 30 minutes. However, it is unknown
which video (regular or interactive) had a bigger influence on
the outcomes. A greater number of children were found to enjoy
the interactive video more than the regular video as well. In this
study, we seek to investigate whether the use of an interactive
educational animated video is non-inferior to showing two
videos (regular and interactive) in improving children’s
cooperativeness during MRI scans.
Methods & Materials: In this Institutional Review Board-
approved prospective, randomized, non-inferiority trial, 462
children aged 3 to 20 years old scheduled for elective MRI scan
during the period of June 2017 to October 2018 at the Singapore
KK Women’s and Children’s Hospital were randomized into
interactive animated video only, and regular cum interactive
animated videos groups. Children were surveyed and shown the
videos before they went in for their MRI scan. Three outcomes
were assessed across the two groups: repeated MRI sequences,
general anesthesia (GA), and improvement in children’s
confidence of staying still for at least 30 minutes.
Results: In the interactive video only group (n = 229), 76
(33.2%) patients needed repeated MRI sequences, 2 (0.9%)
needed GA, and 64 (27.9%) became more confident of staying
still for at least 30 minutes. In the combined videos group (n =
233), 89 (38.2%) patients needed repeated MRI sequences, 4
(1.7%) needed GA, and 66 (28.3%) became more confident of
staying still for at least 30 minutes. The three outcomes are not
significantly different between the two groups using Chi-
squared test at 0.05 significance level.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S78
Conclusions: The interactive animated video group
demonstrated non-inferiority to the combined videos group by
showing a comparable repeated MRI sequences and GA
proportions, and the increase in confidence level of staying still
for at least 30 minutes.
Paper #: 019
Improved Workflow with MRI Protocol Optimization and
Technologist Education
Ami Gokli, [email protected]; Janet R. Reid, MD, FRCPC,
Suraj Serai; Children's Hospital of Philadelphia, Philadelphia,
PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: There has been recent increasing
interest in imaging protocol standardization. At our institution,
challenges to standardization stem from being a large hospital
system with multiple sites and 10 MRI scanners at our facility
alone. Scanners are different ages, designed by different
manufacturers and vary by type. Posted protocols were not
standardized by name and would often not match those within
the MRI scanners. Finally, sequence names on MRI scanners
varied by manufacturer and type of scanner, and these names
would not match posted protocol names. We aim to optimize
imaging protocols by standardizing the MRI naming system,
making protocols readily available, and continuing to maintain
image quality. Our goal is to avoid communication breakdown
between technologists, radiologists and referring physicians and
to add value by providing consistency.
Methods & Materials: A multidisciplinary team including
technologists, radiologists and physicists was assembled and a
standard sequence naming system was agreed upon. The process
of updating the online posted protocols was re-evaluated and
representative “thumbnail” images were associated with each
sequence in a protocol to avoid confusion. A soft launch of the
new system was implemented with the most frequently used
MRI MSK protocol in September 2018. An electronic survey
was distributed in October to identify challenges and acceptance
by technologists.
Results: 22 MRI technologists completed the survey. Of all
respondents, 95.5% (n=21) found the new naming convention
easier to understand with 81% also adding that it positively
affected their workflow (n=18). 57.1% of respondents utilized
the new protocol (n=13) since the soft launch the month prior.
Of those who utilized it, 100% found the new thumbnail images
helpful during the workday (n=13), and 100% also noted that it
should be adopted for all protocols (n=13). 90.9% of responding
technologists noted they would refer to the posted protocols
more often if thumbnail images were included in all protocols
(n=20). Individual suggestions for improvement included
indicating anatomic coverage on thumbnail photos, including
unusual scanning angles, and demonstrating preferred patient
positioning.
Conclusions: MRI protocol optimization including
standardization of protocols, sequences, coverage and a
reference article supporting protocol design was well received
by technologists and improves their daily workflow.
Paper #: 020
Wait Time Reduction for Sedated MRIs
Nicholas A. Zumberge, MD,
[email protected]; Brian Schloss,
MD, Rajesh Krishnamurthy, Phillip McGonagill, BA, Lean Six
Sigma Black Belt, Ramkumar Krishnamurthy, PhD, Akila
Sankaran; Radiology, Nationwide Children’s Hospital,
Columbus, OH
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Large hospitals are facing increased
pressure from free standing imaging facilities for timely sedate
imaging services. Meanwhile, wait times have traditionally been
long due to resource constraints. This study takes a
multifactorial approach to improving wait times for patients that
require an MRI under sedation. Our aim is to apply focused
interventions in reducing wait times at Nationwide Children's
Hospital from 56 days down to 15 days.
Methods & Materials: To reduce sedated MRI (SMRI) wait
times, we looked at 4 key drivers; the first, sedation capacity
(SC). The goal here was to increase sedation resources. The
second key driver we looked at was education. The goal was to
educate patients on the risks of sedation. This approach might
aid in reducing the demand for SMRI slots. We also wanted to
recruit the help of ordering clinicians to share with patients our
information sheet on sedation, and child life contact
information, if families chose to go the non-sedation route. The
third key driver was MRI simulation. With the help of Child
Life, divert more patients to our MRI simulator and/or Virtual
Reality (VR) goggles, then, if successful, on to an unsedated
scan. Finally, reduce MRI scan times. Towards this effort, we
set out to reduce protocol standards to the minimum necessary
for quality scans; as well as reduce sequencing times in order to
further abbreviate scans.
Results: In Aug 2017, we introduced simulator Fridays. With
the aid of Child Life services, eligible patients were offered the
opportunity to try the MRI simulator. Once successful, the child
would then be scheduled for an immediate unsedated MRI. By
Dec 2017, we saw a dip in SMRI wait time from 62 days to 52
days, a 16% improvement. On 01 Feb 2018, we added a third
sedation room on Mondays. The additional sedation resource
achieved the greatest impact. By 30 Sep 2018, wait times had
fallen to a low of 18 days, a 71% reduction from Jul 2017.
Conclusions: By far our most dramatic gains have been from
the increase in sedation resources. We continue to push for
Child Life support for sim MRI and soon the MRI VR goggles.
We are also working with ordering clinics, in an effort to divert
more patients to unsedated scans. We are diligently working to
shorten protocols and sequencing times for scans to further
reduce the SMRI burden. This future abbreviated approach,
with the aid of VR scans, will allow for our Child Life team to
further stratify patients towards non-sedate slots.
Paper #: 021
Pediatric Emergency Medicine Point of Care Ultrasound
Impact on Radiology Ultrasound Volume
Asef Khwaja, MD, [email protected]; Sandra Saade-
Lemus, MD, Rachel Rempell, MD, Aaron Chen, MD, James
Edgar, Summer Kaplan, MD MS; The Children's Hospital of
Philadelphia, Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S79
Purpose or Case Report: Point of care ultrasound(POCUS) use
is growing in pediatric emergency medicine(PEM). At our
institution, POCUS was implemented in the emergency
department(ED) in March of 2013. POCUS is used for teaching,
procedure guidance, and for directing selection of
radiology(RAD) performed exams. POCUS may even replace
RAD ultrasound(US). For example, US evaluation of skin and
soft tissue infections(SSTI) may be performed by RAD or PEM
at our institution. To our knowledge, no studies have assessed
the impact of PEM POCUS on RAD US volume. We
investigated the impact of PEM POCUS at our institution on
RAD US exam volumes in total and for SSTI.
Methods & Materials: In this IRB-exempt study we
retrospectively reviewed monthly US exam volume for RAD
and PEM 60 months before and after existence of an organized
POCUS program in the ED. Exams were identified by exam
type and patient location. SSTI RAD US were identified by key
word search for “soft tissue”. Volume of digital radiography
(DR) in the ED was assessed as control unaffected by POCUS.
A descriptive inspection of exam growth rate using linear
regression was performed. Secondary analysis was performed
while normalizing for total number of ED visits and ED patients
with ICD-10 codes indicating soft tissue infection. Graphical
inspection of data showed a sudden increase in US and DR
volumes preceding POCUS by 28 months, so this period was
excluded from analysis.
Results: Mean monthly US volume after POCUS was 616
exams for RAD and 32 exams for PEM. Rate of RAD US
increased from 2.0-fold per month (p < 0.05) to 4.0-fold per
month (p < 0.001) after POCUS, while POCUS increased at a
rate of 1.2-fold per month (p < 0.001). For SSTI US, RAD
orders from ED were similar before and after POCUS,
increasing at a rate of 0.5-fold per month (p < 0.01), while
POCUS exams for SSTI increased 0.2-fold per month (p <
0.001). Growth rate of RAD US per ED visit was 3x higher than
for POCUS. Growth rate of RAD SSTI US per SSTI diagnosis
was 2.4x higher than for POCUS SSTI, similar to difference in
absolute growth rate for these exams.
Conclusions: Our results suggest that PEM POCUS does not
impair growth of RADS US from the ED. More work is needed
to determine if PEM POCUS for SSTI impaired growth for
RAD US for SSTI, but the small growth in POCUS SSTI exams
suggests lack of growth in RAD US for SSTI is due to nearing
maximum capacity. Results suggest that radiologists should not
fear loss of referrals due to ED POCUS, but should collaborate
with PEM to improve patient care.
Paper #: 022
Non-visualization of the ovaries on pediatric
transabdominal Ultrasound with a non-distended bladder:
can adnexal torsion be excluded?
Gali Shapira - Zaltsberg, MD, [email protected];
Fleming Nathalie, Anna Karwowska, Maria Esther Perez Trejo,
Gerald Guillot, Elka Miller, MD; Pediatric radiology, CHEO,
Ottawa, Ontario, Canada
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: The purpose of this study was to
retrospectively investigate if clinically suspected adnexal
torsion can be excluded based on non-visualization of the
ovaries on transabdominal ultrasound (TUS) with a non-
distended bladder in pediatric patients.
Methods & Materials: This retrospective study comprised 340
girls (4-18 years) who were referred to TUS to assess for
adnexal torsion and/or appendicitis, and the ovaries were
initially not visualized on TUS. Their bladders were
subsequently filled and were rescanned with a distended bladder
showing the ovaries. Ovarian volumes and time between TUS
scans were documented. The ratio of the volume of the larger
ovary to the smaller one was calculated. If ovarian
abnormalities were noted on imaging, the medical record was
reviewed for clinical correlation. A sample size of 340
participants was selected based on a margin of error (MOE)
between 0.75% and 2.3% for an assumed probability of a girl
testing negative for adnexal torsion in the TUS with a full
bladder in the range 0.95-0.995.
Results: None of the girls (0/340) who had a TUS study done
with a non-distended bladder in which the ovaries were not
visualized, had a positive diagnosis of adnexal torsion,
confirming the hypothesis that non-visualization of ovaries on
TUS can help exclude adnexal torsion. Nonetheless, 0.6%
(2/340) of the girls had significantly enlarged ovarian volume
when subsequently visualized after bladder filling, that
radiologically may be concerning for adnexal torsion. The mean
and median time difference between the scans was 105.1 (65.8)
and 89.0 (59.0, 130.5) minutes respectively.
Conclusions: In the right clinical setting, non-visualization of
the ovaries on TUS study can be just as helpful as a negative
study, alleviating the need for bladder filling and prolonging the
wait time in the emergency department. Inclusion of non-
visualization of the ovaries as one of the features in a predictive
score for adnexal torsion should be considered.
Paper #: 023
Introduction of Contrast enhanced voiding urosonography
into clinical practice: Assessment of Clinical Indications,
Imaging results, and Urologist Acceptance.
Fidaa Wishah, MD1, [email protected]; Erika Rubesova,
MD1, Safwan Halabi, MD1, Jesse Sandberg, M.D.1, Edward
Diaz, M.D.2, William A. Kennedy II2, Richard Barth, MD1; 1Department of Pediatric Radiology Lucile Packard Children's
Hospital, Stanford, CA, 2Department of Pediatric Urology
Lucile Packard Children's Hospital, Stanford, CA
Disclosures: Edward Diaz, M.D.: Research Grants: Bracco
Diagnostics as lead PI investigator. All other authors have
disclosed no financial interests, arrangements or affiliations in
the context of this activity.
Purpose or Case Report: Prior studies have validated contrast
enhanced voiding urosonography (ceVUS) to be as accurate as
fluoroscopic VCUG for the diagnosis of vesicoureteral reflux
(VUR). Our purpose is to assess performance of ceVUS in
clinical practice including clinical indications, imaging results
(including adequacy of urethral visualization), and urologist
acceptance.
Methods & Materials: A retrospective review was performed
on 170 consecutive patients (mean age 17.1 months, 91 males,
79 females) referred for ceVUS between 8/4/2017 and
9/14/2018. We used a GE- Logiq E9 machine with a C2-9 probe
in high resolution mode, mechanical index (MI) range (0.06-
0.18), average 0.13. We reviewed clinical indications, duration
of examination, imaging results and follow up VCUG for
inadequate ceVUS. Image evaluation by 4 radiologists included
grading of urethral visualization (0/poor,1/good.,2/excellent).
Urologist acceptance was assessed via questionnaire.
Results: Clinical indications included: hydronephrosis (34%),
UTI (29%),VUR followup (13%), other (24%). Ordering
providers were pediatric urologists in 90%. In 41/170 (24%)
ceVUS was follow-up to fluoroscopic VCUG (22%) or CeVUS
(2%). ceVUS was inadequate in 1/170 (0.6%) and was
converted to VCUG. Average ceVUS examination time was 22
minutes. VUR was found in 25 patients and 83 kidneys(K) -
grade 1 (7K), grade 2 (28K), grade 3 (29/K), grade 4 (15K),
grade (4K). Consensus review graded anterior/posterior urethra
visualization in males as excellent in 52%/40%, good in
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S80
19%/21% and poor in 24%/32%. Urethral visualization in
females as excellent in 58%,good in 10%, poor in 9%. 23/170
patients did not void while imaging. Referring urologists’ online
questionnaire results: Is CeVUS satisfactory for detecting VUR?
(100%), Would you order fluoroscopic VCUG?
sometimes/rarely (66.7/33.3%).VCUG indications included
suspected UPJ obstruction, complex anatomy, posterior urethral
valves, and bilateral grade 4 prenatal hydronephrosis.
66.7/33.3% felt somewhat/very confident in interpreting a
CeVUS without a radiologist. 66.7/33.3% thought that CeVUS
is very/extremely adequate in urethral visualization. 66.7/33.3%
felt definite patient preference/no preference to CeVUS over
fluoroscopic VCUG. Should ceVUS replace fluoroscopic
VCUG nationwide? 66.7% agreed, 33.3% neither agreed or
disagreed
Conclusions: ceVUS was readily integrated into clinical
practice and well-accepted by urologists for diagnosis of VUR
as an alternative to VCUG. Urethra visualization may be
suboptimal and require a VCUG.
Paper #: 024
3D printed anatomic contrast enhanced voiding
urosonography (ceVUS) teaching phantoms: bringing
pediatric vesicoureteral reflux (VUR) to life
Sphoorti Shellikeri, Master's in Biomedical
Engineering, [email protected]; Elizabeth
Silvestro, MSE, Laura Poznick, AAS, ARDMS, Trudy
Morgan, Kassa Darge, MD, PhD, Raymond Sze, Susan J. Back,
MD; Radiology, Children’s Hospital of Philadelphia,
Philadelphia, PA
Disclosures: Kassa Darge, MD, PhD: Research Grants:
Bracco, Lantheus, Siemens, Philips, NIH, Thrasher Society,
Helfer Society, ITMAT, Foerderer, MTR, RSNA, SPR; Susan
J. Back, MD: Research Grant: Siemens, Philips, Educational
Grant: Bracco. All other authors have disclosed no financial
interests, arrangements or affiliations in the context of this
activity.
Purpose or Case Report: Vesicoureteral reflux (VUR) is the
most frequently detected problem of the pediatric urinary tract.
Contrast enhanced voiding urosonography (ceVUS) is a highly
sensitive examination to diagnose VUR. Following FDA
approval for the use of an ultrasound contrast agent for ceVUS
in children, there is increasing interest in learning how to do the
ceVUS examination. Ultrasound (US) phantoms that depict
VUR are not available. We created 3D-printed phantoms as
teaching tools to simulate the grades of VUR during the ceVUS
examination.
Methods & Materials: MR urograms that depicted varying
degrees of urinary tract dilation in infants were identified and
segmented to represent the four highest grades of VUR, one
kidney for each grade. The segmented kidneys were connected
to a CAD generated bladder, urethra, and ureter. Kidneys were
paired to create two models to simulate the 4 grades of reflux
that involved the upper urinary tract. The renal models were
printed in polyvinyl alcohol (PVA) and embedded into a silicon
(smooth-on eco flex 30) mold of an infantile abdomen and
pelvis. The PVA parts were dissolved leaving behind cavities of
the renal anatomy in the silicon. Printed posts were added to
open and close the ureters to simulate grade 1 reflux. A catheter
was placed in the urethra to enable filling.
Results: GE LOGIQ E9 US system with a C2-9 contrast
enabled transducer was used to image the models. One operator
administered the contrast-saline solution in the urethral catheter
while the other obtained US images. The US transducer was
placed on the anatomic regions of the flanks, abdomen and
pelvis with US coupling gel. Still and cine US images were
obtained. Each kidney was easily visualized, as were the ureters
and bladder including visualization of all anatomic structures in
a single image. Images highly resembled clinical examinations.
Conclusions: These ceVUS phantoms are reusable and can be
used as a versatile teaching tool to demonstrate and practice the
ceVUS procedure while depicting the appearance of different
grades of VUR in children.
Paper #: 025 - Withdrawn
Paper #: 026
Comparison of glomerular filtration rate estimated
by motion-robust high spatiotemporal resolution dynamic
contrast enhanced MRI and plasma clearance of 99mTc-
DTPA
Sila Kurugol, PhD1, Onur Afacan, PhD1, Reid Nichols1, Monet
Dugan1, Richard Lee, M.D.2, Simon K. Warfield, Ph.D.1,
Jeanne S. Chow, MD1, [email protected]; 1Radiology, Boston Children's Hospital and Harvard Medical
School, Boston, MA, 2Boston Children's Hospital and Harvard
Medical School, Boston, MA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: The purpose of our study was to
assess the accuracy of measuring glomerular filtration rate
(GFR) using motion-robust high spatiotemporal resolution 3D
dynamic contrast enhanced MRI, by comparison of MRI-GFR
to GFR from 99mTcDTPA nuclear medicine study (NM-GFR).
Methods & Materials: This IRB approved study enrolled
children, between 0-20 years, undergoing both a clinically
indicated contrast enhanced MRI, and a nuclear medicine GFR
study within 2 weeks of each other. Each patient consented for
the study underwent an additional 6-minute dynamic contrast
enhanced MRI scan using the motion-robust high
spatiotemporal resolution dynamic radial VIBE sequence
(Siemens 3T). The images were reconstructed offline using
compressed sensing image reconstruction including
regularization in temporal dimension to improve image quality
and reduce streaking artifacts due to fast imaging. Images were
then automatically post processed using in-house developed
software. Post processing steps included segmentation of kidney
parenchyma and aorta using a convolutional neural network
technique and tracer kinetic model fitting using the Sourbron’s
two-compartment tracer kinetic model to calculate the magnetic
resonance based GFR (MRI-GFR). The MRI-GFR results were
compared to the glomerular filtration rate measured by
99mTcDTPA nuclear medicine study (NM-GFR).
Results: 18 children (average age 5.9, 8 female:10 male) were
enrolled between July 2017- present. The method was
technically feasible in all patients. The results showed that the
MRI-GFR correlated with NM-GFR with r-square value of
0.94. We also performed Bland Altman analysis (i.e. difference
of MRI-GFR and NM-GFR versus mean of NM-GFR and MR-
GFR), which showed a reproducibility coefficient (RPC) of 22
with 95% confidence interval, and the coefficient of variation
(CV) of 8.2% with values between -21 (-1.96 standard
deviation) and 24 (+1.96 standard deviation).
Conclusions: MR-GFR is a reliable method of measuring
glomerular filtration rate and is comparable to the GFR
measured by plasma clearance of 99mTcDTPA.
*Work supported by the SPR Research and Education
Foundation
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S81
Paper #: 027
Correlation of MR-Urography and intravoxel incoherent
motion MRI based estimation of split renal function in the
pediatric clinical population
Patrice Grehten, MD1, [email protected]; Christian
J. Kellenberger, MD1, Andras Jakab, MD, PhD2; 1Diagnostic
Imaging, University Children's Hospital Zurich, Zurich,
Switzerland, 2Center for MR-Research, University Children's
Hospital Zurich, Zurich, Switzerland
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To evaluate the usability of
intravoxel incoherent motion MRI (IVIM) for predicting split
renal function in the pediatric population undergoing clinically
indicated functional MR-Urography
Methods & Materials: We retrospectively analyzed data of 41
children (age: 38.8 ± 33 months) with morphologically normal
kidneys or urinary tract dilation. High-resolution 3D T2-CUBE,
dynamic MR urography and IVIM were acquired with free
breathing on a 1.5T MRI scanner. IVIM was co-registered to
T2-CUBE and an in-house developed tool was used for motion
correction. We utilized the IVIM model to separate diffusion
and perfusion in the renal cortex, medulla and pelvis after
manually delineating in largest coronal cross-section and 2
further slices from coronal mid-plane. Split renal function was
evaluated with the volume adjusted Patlak method based on the
post contrast dynamic MR-Urography.
Results: After correcting for age and sex, we found a moderate
correlation between renal transit time and the cortex perfusion
fraction (f) (Pearson partial correlation coefficient, r=0.315,
p=0.006), medulla f (r=0.270, p=0.025), pelvis pseudo-diffusion
coefficient (r=0.383, p=0.0001) and a negative correlation with
pelvis f (r=-0.292, p=0.012) as well as negative correlation of
split kidney function with the cortex f (r=-0.270, p=0.037).
Conclusions: Our results provide evidence that IVIM imaging
is useful to evaluate split renal function. We propose that the
separation of perfusion and diffusion processes is necessary to
estimate renal function in children using diffusion MRI. Image
processing and statistical models adjusting for patient age were
necessary to reveal correlations between microvascular
perfusion and function, however, we did not find similar
correlation with the diffusion coefficient.
Paper #: 028
Identifying Calyceal Diverticula at Magnetic Resonance
Urogram in Children
Juan S. Calle Toro, MD, [email protected]; Susan J. Back,
MD, Kassa Darge, MD, PhD, Hansel J. Otero, MD; Radiology,
Children’s Hospital of Philadelphia, Philadelphia, PA
Disclosures: Susan J. Back, MD: Research Grant: Siemens,
Philips, Educational Grant: Bracco; Kassa Darge, MD, PhD:
Research Grants: Bracco, Lantheus, Siemens, Philips, NIH,
Thrasher Society, Helfer Society, ITMAT, Foerderer, MTR,
RSNA, SPR. All other authors have disclosed no financial
interests, arrangements or affiliations in the context of this
activity.
Purpose or Case Report: To report the frequency of calyceal
diverticula (CD) as seen at functional MR urography (fMRU)
and determine the ability of fMRU to diagnose calyceal
diverticulum in a pediatric cohort.
Methods & Materials: This is an IRB-approved retrospective
study of all patients with suspected CD that underwent fMRU at
our institution. Two-pediatric radiologists reviewed each fMRU,
blinded to clinical information and other imaging, to determine
the presence, morphology and contrast accumulation in cystic
lesions suspected of being CD. Each radiologist made a
determination of cyst or CD solely based on the presence of
contrast within the lesion. Size and location were also recorded.
The timing at which the contrast was first seen within the lesion
and the pattern of contrast within the lesion (i.e. complete filling
versus layering contrast) were also recorded. The diagnosis of
CD was confirmed by either surgery, retrograde pyelogram or
acknowledgement of fMRU results in the urologic clinical note.
Chi-square was used to examine differences between
characteristics of cysts versus diverticula. Inter-reader
agreement was also calculated with kappa.
Results: A total of 66 lesions from 52 studies in 50 children (29
girls and 21 boys; mean age 10.9 ± 5.7 years) were included.
Nineteen (28.8%) lesions demonstrated contrast filling, hence
characterized as diverticula; while the remaining 47 (71.2%)
were cysts. The overall frequency of CD in our sample was 18
cases per 1000 patients. The average size of CD was 2.3 cm (+/-
1.2 cm). CD were more common in the right side (58% versus
42% in the left) and in the upper pole (42% versus 32% and
26% in the interpolar and lower pole, respectively); all of the
CD were medullary. Contrast filling was observed on average at
4.0 minutes (SD +/- 2.4; range 1.5-13 minutes). There was
complete opacification of the CD in the majority (n=12, 63%) of
cases. The agreement between radiologists was 91%
(kappa=0.78). 18 cysts and 6 CD were confirmed invasively
with a 100% match between fMRU and invasive technique
diagnosis.
Conclusions: Calyceal diverticula, as seen at fMRU, are at least
three times more frequent that previously reported during
intravenous urograms. Moreover, fMRU is an accurate
diagnostic tool to differentiate calyceal diverticula from renal
cysts. In our sample, all diverticula were identified within a 15
minute delay cut-off, which allows to perform shorter
examinations. Delays of over 30 minutes are hence unnecessary.
Paper #: 029
Distinguishing clinical and imaging characteristics of
nephrogenic rest vs. small Wilms tumor: a report from the
Children’s Oncology Group
Jesse Sandberg, MD4, [email protected]; Ethan A.
Smith, MD1, Fredric Hoffer, MD11, Sabah Servaes, MD2, Yueh-
Yun Chi10, Elizabeth Mullen, MD, FAAP3, Elizabeth Perlman,
MD5, Peter Ehrlich, MD6, James Geller, MD7, Jeffrey Dome,
MD/PhD8, Conrad V. Fernandez, MD9, Geetika
Khanna4; 1Section of Pediatric Radiology, Cincinnati Children's
Hospital, Cincinnati, OH, 2Department of Radiology, Children's
Hospital of Philadelphia, Philadelphia, PA, 3Department of
Pediatric Oncology, Children’s Hospital Boston/Dana-Farber
Cancer Institute, Boston Children's Hospital, Boston,
MA, 4Mallinckrodt Institute of Radiology, Washington
University School of Medicine, St. Louis, MO, 5Department of
Pathology and Laboratory Medicine, Ann & Robert H. Lurie
Children's Hospital of Chicago and Northwestern University
Feinberg School of Medicine, Chicago, IL, 6Section of Pediatric
Radiology, Department of Radiology, C.S. Mott Children’s
Hospital, University of Michigan Health System, Ann Arbor,
MI, 7Division of Pediatric Oncology, Cincinnati, Children’s
Hospital Medical Center, University of Cincinnati, Cincinnati,
OH, 8Division of Pediatric Oncology, Children’s National
Medical Center, Washington, DC, 9Department of Pediatrics,
Dalhousie University & IWK Health Centre, Halifax, Nova
Scotia, Canada, 10Department of Biostatistics, College of Public
Health & Health Professions College of Medicine, University of
Florida, Gainesville, FL, 11Department of Radiology, University
of Washington, Seattle, WA
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S82
Disclosures: Geetika Khanna, MD, MS: Financial Interest:
Elsevier - Royalty: Independent contractor. All other authors
have disclosed no financial interests, arrangements or
affiliations in the context of this activity.
Purpose or Case Report: Nephrogenic rests (NR) are known
precursors for Wilms tumor (WT). Distinguishing between NR
and small WT can be challenging and relies on pathological
identification of capsule around the WT. Prior publications have
suggested that homogeneity of lesion and elliptical shape favor
the diagnosis of NR over WT. Interpretation of these studies
was limited by small sample sizes or pre-biopsy chemotherapy.
The purpose of this study was to identify if clinical and/or
imaging findings robustly distinguish NR from WT.
Methods & Materials: All cases of pathologically diagnosed
NRs and a comparison group of WT (< 5 cm) in patients <5
year of age were identified from the Children's Oncology Group
renal tumor biology, banking and classification study
(AREN03B2) (July 2006-Aug 2016). Exclusion criteria:
chemotherapy prior to pathological evaluation and >30days
between imaging and surgical sampling. Two radiologists
blindly assessed all lesions on available CT/MR images for size,
shape, interface (lesion margin) and, location and homogeneity.
All cases underwent central pathology review. Two-sample t-
test was used for continuous variables, and Fischer's exact test
for categorical variables. Receiver operating characteristic
(ROC) analysis was performed to determine size cutoff for
differentiating rests vs. WT.
Results: 31 cases with rests (20 perilobar, 11 intralobar) and 29
WT were identified. History of a predisposition syndrome (46%
rests, 11.5% WT, p 0.03) and younger age (median age rest
1.10, range 0.22-4.04 years, WT 3.28, range 0.36-5.57 years, p
<0.001) were more common in NR cases. Median diameter of
NR was 1.3 cm (0.7-3.4) vs. WT 3.2 cm (1.8-4.9) (p < 0.001).
Imaging findings supportive of WT included a round, exophytic
lesion (p <0.001). Imaging assessment of interface was not
predictive of NR vs. WT (p 0.20). Perilobar rests (83%) were
more likely to be homogeneous compared to intralobar rests
(30%) or WT (10%) (p <0.001). ROC analysis showed that in
lesions <5cm, optimal cutoff between rest vs. WT was 1.75 cm
(p <0.001). The size cutoff remained the same at 1.75cm after
excluding WT 4-5cm in size (p<0.001).
Conclusions: In children <5 years of age, diagnosis of WT
should be favored over NR when a renal mass is round and
exophytic. Homogeneity favors the diagnosis of perilobar NRs.
Imaging is not effective in identifying capsule (a key
pathological discriminator of NR vs WT). We suggest 1.75 cm
as the optimal cutoff for differentiating between NR vs. small
WT.
Paper #: 030
Enhancing Presurgical 3D Modeling and Printing:
Multiphase MRI Technique
Elizabeth Silvestro, MSE, [email protected]; Thomas
Kolon, MD, Douglas Canning, MD, Robert H. Carson, B.S.R.T.
R,MR, Suraj Serai, Raymond Sze, Susan J. Back, M.D.;
Radiology, Children's Hospital of Philadelphia, Philadelphia,
PA
Disclosures: Susan J. Back, MD: Research Grant: Siemens,
Philips, Educational Grant: Bracco. All other authors have
disclosed no financial interests, arrangements or affiliations in
the context of this activity.
Purpose or Case Report: The process of anatomic 3D
modeling and printing conventionally is done from one imaging
set, inherently limiting the visibility and detail of some
structures. Multiphase post contrast image acquisition and
intracavitary contrast instillation allows construction of
composite models using sequences optimized for specific
anatomic detail. This technique is ideal for renal tumor or
genitourinary modeling. Applications include preoperative
oncologic and reconstructive imaging.
Methods & Materials: Multiphase gadolinium enhanced
sequences were obtained as part of a preoperative MRI
examination. Delayed phase imaging detailed the renal
collecting system and ureters when applicable. Direct
instillation of dilute gadolinium into the urinary bladder and
vagina facilitated defining cavitary anatomy. Following
acquisition, images were reviewed and selected for
segmentation. A sequence was selected as an anatomic
reference to alignall required structures. Images detailing
arterial, venous, renal collecting system and cavitary anatomy
were selected. Each structure was segmented independently
using threshold and contouring tools. The desired structures
were exported and overlaid together on the reference scan. If
there was variation in size or orientation of a scan an unrelated
structure, such as the spine, was segmented and used to resize
and orient the regions of interest. Finally, posting and coloration
were added to the model to illustrate any focus of the surgery or
diagnosis depending on the capability of the available additive
manufacturing machine, or 3D printer.
Results: The process of acquiring and modeling anatomy can be
applied to numerous surgical and diagnostic applications. The
most promising uses thus far have been to model the
relationships of renal arteries, veins and collecting system in
Wilmstumor. Urologist(s) remarked that 3D models aided
comprehension and conceptualization of the imaging anatomy.
Furthermore, one model was used to plan a multidisciplinary
surgical approach as well as educate the patient and family.
Conclusions: Multiphase scan segmentation technique can
produce a complexmodel without compromising structural
detail. The composite model aids preoperative planning for
complex surgeries. This process can be extended to merging of
any temporally related images.
Paper #: 031
Adolescents With Obesity:Carotid Intima Media Thickness
(cIMT) and Cardiovascular (CV) Risk Factors
Suzanne E. Cuda, MD, Maria-Gisela Mercado-Deane, MD,
[email protected]; Children's Hospital of San Antonio,
San Antonio, TX
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Atherosclerosis begins in childhood
and progresses throughout life. Current management of
adolescents with obesity (AWO) is not directly linked to CV
risk. Instead, we use surrogate measures such as the components
of the metabolic syndrome (MS) or biomarkers. Noninvasive
imaging using carotid ultrasound is used in other at risk
pediatric populations but has not been used among AWO except
to note that it is increased as compared to normal weight
controls. In this pilot study we investigate associations between
CV risk factors (%BMIp95, lipid profile, HbA1c, blood
pressure, fasting blood glucose and insulin, liver function tests
and high sensitivity C reactive protein) and cIMT in AWO
between the ages of 13-17 years. The normal increase in cIMT
is 0.009 mm per year.
Methods & Materials: 77 AWO, ages 13-17(45M/32F) were
enrolled on their baseline visit to a pediatric weight
management clinic. Criteria for inclusion: BMI>95th percentile
for age, and no type 2 diabetes mellitus prior to presentation.
Baseline laboratories for CV risk factors and cIMT were
compared across increasing %BMIp95. cIMT was measured by
taking the average of the common carotid artery measurements
(Avg CCA).
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S83
Results: Mean age 15.16 years, mean BMI 38.27 kg/m2. Both
age (P=0.0265) and systolic blood pressure (SBP) (P=0.0179)
were significantly associated with Avg CCA using a simple
linear regression model. No other variables were significantly
associated with Avg CCA. After simultaneously adjusting for
age and SBP in a multiple linear regression model, Avg CCA
increased by 0.0125 mm per year increase in age (95% CI:-
0.002, 0.027;P=0.10). Avg CCA increased by 0.0168 mm per 10
mm Hg increase in SBP (95% CI: -0.001,0.035;P=0.064).
Conclusions: CIMT significantly increases with age and
systolic blood pressure in AWO. The rate of increase of Avg
CCA per year of age exceeds the expected rate. No other CV
risk factors were significantly associated with increases in Avg
CCA. There was no significant increase in Avg CCA with
increase in %BMIp95.
Paper #: 032
Longitudinal Assessment of Imaging Features of
Generalized Arterial Calcification of Infancy
Sara Cohen, MD, [email protected]; Christian A.
Barrera, M.D., David M. Biko, MD, David Saul, MD, Ammie
M. White, MD, Hansel J. Otero, MD; Children’s Hospital of
Philadelphia, Philadelphia, PA
Disclosures: David M. Biko, MD: Financial Interest: Wolters
Kluwer - Royalty: Editor of Review Book. All other authors
have disclosed no financial interests, arrangements or
affiliations in the context of this activity.
Purpose or Case Report: Generalized arterial calcification of
infancy (GACI), also known as idiopathic infantile arterial
calcification, is a rare genetic disorder characterized by
calcifications and injury to large and medium size vessels. We
aim to describe the imaging findings of GACI in children.
Methods & Materials: This is a retrospective review of initial
and follow up CT, CTA, MRA, and vascular ultrasound
imaging in children with confirmed GACI at a single institution.
All initial imaging studies were reviewed for the presence and
distribution of arterial calcifications, stenosis, and wall
thickening/irregularity within the chest, abdomen, and pelvis.
Available follow up studies were compared to initial imaging
findings. A chart review was performed for clinical history.
Results: A total of 8 patients (5 boys) from 6 families (2 sets of
siblings) were identified. Patients presented prenatally (n=4); or
with cardiac failure (n=2), seizures (n=1), or hypertension
(n=1). Average follow up was 37 months (range 0 – 11 years).
A single death occurred at 2 months of age.5 patients underwent
imaging at birth and all had arterial calcifications as follows:
aorta (n=4), pulmonary (n=3), mesenteric (n=3), renal (n=3),
iliac (n=3), subclavian (n=2), brachiocephalic (n=1), common
carotid (n=1), coronary (n=1), and splenic (n=1) arteries. 1
patient had main pulmonary artery stenosis and 1 had bilateral
renal artery stenosis.4 of the newborn patients underwent follow
up imaging between 1 month and 3 years of age. Calcifications
were: decreased (n=2), resolved (n=1), or stable (n=1). Stenosis
was new or progressed in these 4 patients as follows: renal
(n=3), pulmonary (n=2), aorta (n=2), mesenteric (n=2), and iliac
(n=1) arteries. Vessel wall irregularity/thickening developed in
the pulmonary (n=1), aorta (n=1), mesenteric (n=1) and renal
(n=1) arteries. 1 patient in this age group underwent initial
imaging and was found to have renal artery stenosis and no
calcifications.5 patients over 3 years of age underwent imaging
(3 follow up and 2 initial), none of which had calcifications.
Both initial studies in older siblings were normal. The follow up
studies showed: stable infrarenal aortic, mesenteric and renal
artery stenosis (n=1); progressive renal artery stenosis (n=1);
and improved renal artery stenosis (n=1).
Conclusions: Patients with GACI have characteristic vascular
calcifications at birth. While calcifications may decrease or
disappear with treatment, disease progression may occur in
terms of stenosis and wall irregularity.
Paper #: 033
Value of emergent pediatric cardiac computed tomographic
angiography service: Initial experience at a large children’s
hospital.
Siddharth P. Jadhav, MD1, [email protected];
Pamela Ketwaroo1, Snehal R. More2, Gilbert Rizarri1, Prakash
M. Masand, MD1; 1Radiology, Texas Children's Hospital,
Houston, TX, 2vRad, Eden Prairie, MN
Disclosures: Prakash M. Masand, MD: Consultant,
Honoraria: Canon Medical Systems, Phillips MRI Users
Meeting 2018, Daiichi Sankyo, Speakers Bureau: Canon
Medical Systems, Royalty: Amirsys. All other authors have
disclosed no financial interests, arrangements or affiliations in
the context of this activity.
Purpose or Case Report: With newer generation scanners
providing free-breathing, high-resolution cardiac imaging at sub
milli-Sievert radiation dose, demand for pediatric cardiac
computed tomography angiography (CTA) is increasing. It is
only a matter of time before sub-specialized emergent cardiac
CTA service during weekends and after-hours on weekdays will
become an expectation for optimal patient care. The purpose of
this study is to describe our experience of providing this service
and its effect on patient care.
Methods & Materials: We retrospectively identified all
patients that underwent after-hours weekday or weekend
emergent cardiac CTA between January 2017 and August 2018.
Sub-specialized cardiac CTA in the setting of congenital heart
disease and coronary imaging were included. Routine vascular
imaging in patients without structural heart disease, such as for
aortic dissection, is commonly handled by non-cardiac trained
radiologists and was therefore excluded. Data collected included
day and time of CTA, patient age, indication, patient location,
post-op status, need for anesthesia, need for surgery,
intervention and/or change in medical management based on the
emergent CTA.
Results: A total of 47 studies were identified, 26 (55%) of
which were performed on a weekend or holiday and 21(45%)
after 5 PM on a weekday. These were performed under direct
supervision of a cardiac imager (1 of 3 FTE’s). 28 (60%) were
male. 34 (72%) were in infants out of which 19 (40%) were
neonates. 16 (34%) patients were imaged for coronary artery
evaluation, 9 (19%) for post-op conduit and shunt evaluation
and 8 (17%) for aortic arch. Only 7 (15%) patients needed
sedation with breath-holding for CTA, all of which were infants
needing evaluation of coronaries. One patient was already
intubated prior to CTA. 27 (57%) patients were from the ICU, 9
(19%) from intermediate care unit and 11 (23%) from the
emergency room. Half (n=24, 51%) had at least 1 surgery for
congenital heart disease at time of imaging. 29 (62%) CTA’s
had positive findings explaining patient’s symptoms. Following
CTA, 20 (43%) patients underwent either surgery or an
interventional procedure, and 9 (19%) had change in medical
management based on CTA findings. Surgery/intervention delay
from CTA ranged from 0 days to 29 days with median of 3.5
days.
Conclusions: Emergent pediatric cardiac CTA is a valuable
service leading to a change in management in 62% of our cases.
Larger multi-institutional studies will be needed to ascertain if
outcomes are affected by this service.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S84
Paper #: 034
Intravenous Contrast Material Injection Protocol for
Coronary CTA in Children: Changing The Paradigm From
Contrast Volume To Injection Duration
Luisa F. Cervantes1, [email protected]; Juan C.
Infante, MD2, Viky Loescher, MD3, Juan Carlos Muniz, MD1,
Joshua B. Gruber, MSPH1; 1Nicklaus Children's Hospital,
Miami, FL, 2University of Miami, Miami, FL, 3Mount Sinai
Medical Center, Miami Beach, FL
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Optimal coronary artery
opacification in pediatric coronary artery CTA (CCTA) is
highly dependent on appropriate administration of contrast
material. There is no standard prescription for contrast volume,
injection duration (ID), injection rate (IR), and timing in
pediatric CCTA. We sought to assess the efficacy of an
intravenous contrast administration protocol based on a fixed ID
and either a weight-based IR (< 50kg) or fixed IR (>50kg) to
achieve optimal coronary enhancement in pediatric CCTA.
Methods & Materials: Patients who underwent CCTA at our
institution from 2015 to 2018 were retrospectively evaluated.
Studies with a fixed ID (14 or 16 sec) and a weight-based or
fixed IR were included. Timing bolus was utilized in all studies.
Age, weight, indication, contrast administration parameters (ID,
IR, contrast volume, additional delay from timing bolus peak
enhancement), and acquisition parameters (kV, scan time, CTDI
volume, and DLP) were recorded. Vascular enhancement was
measured as mean attenuation in Hounsfield units (HU) at the
aortic root, proximal right and left coronary arteries, distal right
coronary artery (RCA), and descending aorta. Optimal
enhancement was defined as > 350 HU. The presence and
location of artifact from the incoming contrast bolus was noted.
Results: 109 CCTAs were performed in 108 patients. Median
age was 13.5 years (range 4 - 20). Median weight was 51.5 kg
(range 20.5 - 118). Injection duration was 14 sec in 50% and 16
sec in 50%. Median injection rate for patients <50 kg was 0.1
mL/kg/sec. For patients >50 kg, the injection rate was 5 mL/sec
in 58% and 5.5 mL/sec in 35%. Median contrast volume
(including the timing bolus) was 1.9 mL/kg (range 1.0 - 2.6). No
patient had significant bolus artifact in the superior vena cava or
right heart obscuring the coronary arteries. In 5%, there was
mild or moderate bolus artifact at the level of the right
pulmonary artery. Optimal enhancement in the aorta and
proximal coronary arteries was achieved in 95% of the patients.
Suboptimal enhancement of the distal RCA was seen in 11% of
patients with optimal opacification of the proximal coronary
arteries. Enhancement was higher in patients scanned at lower
kV.
Conclusions: Optimal coronary artery opacification can be
achieved in pediatric patients utilizing a fixed injection rate and
an injection duration protocol of 14 or 16 seconds.
Paper #: 035
Contrast extravasation using power injectors for contrast-
enhanced computed tomography in children: Safety profile
and injury severity assessment
Christian A. Barrera, M.D.,[email protected];
Ammie M. White, MD, Ashley M. Shepherd, Patricia Mecca,
BSRT, R,CT, MR, David M. Biko, MD, David Saul, MD,
Hansel J. Otero, MD; The Children's Hospital of Philadelphia,
Philadelphia, PA
Disclosures: David M. Biko, MD: Financial Interest: Wolters
Kluwer - Royalty: Editor of Review Book. All other authors
have disclosed no financial interests, arrangements or
affiliations in the context of this activity.
Purpose or Case Report: To evaluate the safety of power
injector use in contrast-enhanced CT in children
Methods & Materials: We searched our institution’s medical
records for patients age 0 - 18 years old who received
intravenous contrast agent for a computed tomography between
the dates of April 2015 - April 2018. The inclusion criteria were
an IV contrast injection performed using a power injector. Data
collected included patient demographic information, power
injector information, catheter gauge, injection site and contrast
agent. Then, we identified all confirmed cases of contrast
extravasation in our sample. Contrast extravasations are
classified at our institution according to our Peripheral
Intravenous Infiltration and Extravasation (PIVIE) system into
mild, moderate, severe and severe with an injury. T-test and
Chi-square for gross analysis. For a sub-analysis, non-
parametric tests were used. A p-value of < 0.05 was considered
significant.
Results: 2,429 contrast-enhanced CTs performed with a power
injector were identified. 18 contrast extravasation cases were
confirmed, for a prevalence of 0.7%. 1,496 cases (823 boys and
673 girls) had complete information from the power injector.
The mean contrast dose was 59.3 ± 34.5 mL. Iohexol was the
most commonly used contrast medium (98.6%) followed by
Iodixanol (1.3%). The mean peak pressure was 68.9 ± 62.3 psi
and the flow rate was 1.7 ± 0.9 mL/s. Regarding patients with
extravasation, the mean age was 11.2 ± 6.2 years; the most
common peripheral IV access site was the antecubital fossa (n =
12). The most common catheter size was 22 gauge (n = 8) and
the median catheter dwelling time was between 0 – 3 days. The
contrast agents used were Iohexol 350 mg/dL (n = 12) and
Iohexol 300 mg/dL (n = 6). The PIVIE score observed were
seven mild, six moderate and five severe. There is no difference
in PIVIE score with respect to flow rate, peak pressure, catheter
dwelling time, catheter size, catheter injection site, ultrasound
guidance and contrast agent (p > 0.05). Cases with extravasation
had significantly higher peak pressure (p < 0.001) and flow rate
(p < 0.001) compared to those without extravasation. Patients
who received Iohexol 350 had a significantly higher incidence
of contrast extravasation compared to those who used Iohexol
300 (p = 0.03).
Conclusions: The use of power injectors in children undergoing
contrast-enhanced CT is safe under current standards. However,
a significantly higher rate of extravasation was seen in patients
receiving contrast with a higher viscosity.
Paper #: 036
Diagnostic performance of CT Angiography to detect
pulmonary vein stenosis in children
Christian A. Barrera, M.D., [email protected];
Hansel J. Otero, MD, Jordan B. Rapp, MD, David Saul, Ammie
M. White, MD, David M. Biko, MD; Radiology, The Children's
Hospital of Philadelphia, Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To assess the diagnostic accuracy of
CT Angiography (CTA) to detect pulmonary vein stenosis in
newborns, infants and toddlers
Methods & Materials: We retrospectively identify patients
younger than 4 years who have undergone cardiac CTA and had
either conventional angiography or surgery confirming or
excluding a diagnosis of pulmonary vein stenosis. We excluded
patients with previous surgery involving the pulmonary veins,
exclusively right-heart conventional angiography or insufficient
data in the operation note to confirm the presence or absence of
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S85
pulmonary vein stenosis. Demographic information, CT
parameters and radiation dose were recorded. Two pediatric
radiologists, blinded to clinical data, evaluated each case
independently, determine the presence of stenosis and the
pulmonary veins affected. Disagreement between the readers
were solved by consensus with a third senior reader. The
sensitivity, specificity, positive predictive value (PPV), negative
predictive value (NPV), and accuracy of CTA and their 95% CI
were calculated. Inter-observer agreement was evaluated with
kappa statistics. Scores of 0.41 – 0.60, 0.61 – 0.80 and ≥ 0.80
were regarded as moderate, good, and excellent agreement,
respectively. Descriptive values were reported as mean ± SD.
Results: 28 patients (11 girls, 17 boys) were included in the
final sample. The mean age, weight, height and BSA were 4.9 ±
6.7 months, 4.5 ± 2.1 kg, 55.2 ± 8.7 cm and 0.25 ± 0.09 m2,
respectively. The mean effective dose was 0.5 ± 0.4 mSv. The
pulmonary veins status was confirmed by conventional
angiography in 22 patients and during surgery in 6 patients. The
mean time between the gold standard and CTA was 0.7 ± 1.0
month (range: 1 day - 3 months). Thirteen cases with confirmed
pulmonary vein stenosis were identified and evaluated. The
interobserver agreement was moderate (k = 0.70). Six cases
were resolved in consensus. The diagnostic performance at
patient level showed the sensitivity, specificity, PPV and NPV
were 78.5% (49.2%–95.3%), 87.5% (61.6%–98.4%), 84.2%
(59.3%–95.4%), 82.3% (62.7%–92.8%) and 82.3% (62.7%–
92.8%). The performance at the pulmonary vein level showed
sensitivity of 73.3% (54.1%– 87.7%), specificity of 98.8%
(93.9%– 99.9%), PPV of 95.6% (75.6%–99.4%) and NPV of
91.6% (85.8%–95.2%).
Conclusions: CTA is a reliable image technique with a high
specificity, PPV and NPV to identify pulmonary vein stenosis in
young children performing better when analyzed at the
individual vein level.
Paper #: 037
Feasibility and Utility of Dual-Energy Chest CTA for
Preoperative Planning in Pediatric Pulmonary Artery
Reconstruction
Evan J. Zucker, MD1, [email protected]; Aya Kino,
MD1, Heiko Schmiedeskamp, PhD2, Virginia Hinostroza, BS,
BA1, Dominik Fleischmann, MD1, Frandics P. Chan, MD,
PhD1; 1Stanford University, Stanford, CA, 2Siemens
Healthineers, Forchheim, Germany
Disclosures: Heiko Schmiedeskamp, PhD: Salary: Siemens
Medical Solutions USA; Dominik Fleischmann, MD:
Research Grants: Siemens Healthineers. All other authors have
disclosed no financial interests, arrangements or affiliations in
the context of this activity.
Purpose or Case Report: To assess the added value of
preoperative dual-energy (DE) chest CTA for pulmonary artery
(PA) reconstruction planning.
Methods & Materials: Pediatric PA reconstruction candidates
were prospectively recruited for a new dose-neutral DE CTA
protocol (rather than anatomy-only) from Feb 2017-Oct 2018.
Studies were performed in end-inspiration on a Siemens Flash
(parameters- tube A: 80 kVp/150-200 ref mAs; tube B: Sn140
kVp/64-85 ref mAs; pitch: 0.7), using main PA bolus timing
and 2 mL/kg IV contrast. For each case, the severity of
anatomic PA obstruction was graded by two pediatric
cardiovascular radiologists in consensus using a modified
Qanadli index (each segment scored for stenosis as- 0: none, 1:
<50%, 2: 50-69%, 3: >=70%). Pulmonary blood volume
(PBV)/iodine maps were qualitatively reviewed and auto-
segmented using Siemens syngo.via software, providing mean
Hounsfield unit (HU) attenuation of each lung to the lobar level.
Associations between Qanadli scores (QSs) and PBV were
assessed with Spearman correlation (r) and ROC analysis.
Effective radiation doses (EDs) were estimated from scan DLP
and ICRP 103 k-factors, using cubic Hermite spline
interpolation for age gaps.
Results: 16 patients were recruited with mean (SD) age of 6.4
(5.4) years (range: 1.1-18.8 years), 10 (62.5%) female, 11 (68.8
%) anesthetized. Indications were: redo unifocalization (7,
43.8%), TOF with PA stenosis (3, 18.8%), primary PA stenosis
(6, 37.5%), and 1 post-op CPAM (6.3%), as a normal-PA
control. Mean (SD) scan time, ED, and total QS were 2.2 (0.8)
sec, 1.7 (0.5) mSv, and 35.7 (12.9), respectively. Higher QS
correlated with lower PBV (normalized in each case to the
average HU of the combined lungs), both on a whole lung (r = -
0.57, p = 0.001) and lobar (r = -0.50, p < 0.001) basis. In
addition, the lung with lowest normalized PBV was predictive
of the highest %Qanadli obstruction (assigned score/total
possible points), with AUC of 0.72 (95% CI: 0.47-0.97).
Qualitatively, PBV maps were heterogeneous, corresponding to
multifocal PA stenoses, with visually decreased iodine content
in areas of most severe obstruction (e.g., unilateral absent PA).
All scans were anatomically diagnostic.
Conclusions: DE chest CTA is feasible for pediatric PA
reconstruction candidates, and PBV deficits correlate with more
severe anatomic obstruction. PBV maps facilitated by DE CTA
may improve identification of the most heavily diseased PA
segments and serve as a novel biomarker in this population.
Paper #: 038
Correlation of ductus arteriosus length and morphology
between computed tomographic angiography and catheter
angiography and their relation to ductal stent length
Siddharth P. Jadhav, MD1, [email protected];
Varun Aggarwal2, Prakash Masand1, Wei Zhang1, Athar
Qureshi1; 1Radiology, Texas Children's Hospital, Houston,
TX, 2Baylor College of Medicine, Houston, TX
Disclosures: Prakash Masand, MD: Consultant, Honoraria:
Canon Medical Systems, Phillips MRI Users Meeting 2018, Daiichi Sankyo, Speakers Bureau: Canon Medical Systems,
Royalty: Amirsys. Athar Qureshi, MD: Consultant: W.L Gore
and Associates and Edwards Lifesciences Corp. All other
authors have disclosed no financial interests, arrangements or
affiliations in the context of this activity.
Purpose or Case Report: Patent ductus arteriosus (PDA) stent
placement in infants with ductal dependent pulmonary blood
flow is being increasingly adopted in clinical practice. PDA
stenting can be challenging due to variable anatomy. The
purpose of this study is to correlate computed tomographic
angiographic (CTA) morphology and length of the PDA with
catheter angiography (CA) and its relation to eventual PDA
stent length.
Methods & Materials: We retrospectively identified all
pediatric patients that underwent PDA stenting at our institute
from 2004-2017. Patients who had CTA prior to stenting were
included. PDA length was measured by a radiologist blinded to
the CA data, using Syngo-via post-processing software
(Siemens, Germany). Vessel centerline technique was used. The
actual length of the duct as well as straight length between
aortic and pulmonary ends was measured. The PDA
morphology was classified as straight (type I), mildly tortuous
with 1 turn (II) and tortuous with >1 turn (III). The PDA was
also measured and morphology classified on catheter
angiography by an interventional cardiologist blinded to the
CTA findings. The CTA and CA lengths, straight lengths and
stent length were compared using scatter plots and Pearson
correlation.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S86
Results: A total of 83 patients that had PDA stenting were
identified of which 17 had prior CTA. 15 of these were
neonates. There was agreement between CTA and CA regarding
the PDA morphology in 94% cases. There was good agreement
between CTA and CA actual and straight PDA lengths with
Pearson correlation coefficients of 0.71 and 0.80 respectively.
There was good agreement between CTA actual length, CTA
straight length, CA actual length, CA straight length and
eventual stented PDA length with Pearson correlation
coefficients of 0.61, 0.75, 0.73 and 0.72 respectively. The
correlation was higher for CTA straight length that CTA actual
length presumably reflecting straightening of some of the
tortuous ducts post-stenting.
Conclusions: PDA length and morphology description on CTA
correlates well with CA and can be a reliable guide for the
interventional cardiologist in decision-making regarding
appropriate choice of PDA stent length.
Paper #: 039
Blood flow redistribution in fenestrated and completed
Fontan circulations: With special emphasis on abdominal
flow
Pablo Caro Domínguez, [email protected]; Govind
B. Chavhan, MD, DABR, Lars Grosse-Wortmann, Mike Seed,
Deane Yim, Prashob Porayette, Christopher Lam, Shi-Joon
Yoo; The Hospital for Sick Children, Toronto, Ontario, Canada
Disclosures: Govind B. Chavhan, MD, DABR: Consultant,
Honoraria: Bayer, Inc. All other authors have disclosed no
financial interests, arrangements or affiliations in the context of
this activity.
Purpose or Case Report: The aim was to assess the blood flow
distribution in the fenestrated and completed Fontan statuses as
compared to normal using phase contrast magnetic resonance
and to correlate them with abdominal MR imaging findings.
Methods & Materials: We identified 39 children with
fenestrated or completed Fontan circulation in whom phase-
contrast velocity mapping of major thoracic and abdominal
vessels was a part of the magnetic resonance (MR). The patients
were divided into 3 groups: fenestrated Fontan group with MR
under general anesthesia (GA) (15 patients, average age 5.87
years), completed Fontan group with MR under GA (6 patients,
average age 8.74 years) and completed Fontan group with MR
without GA (18 patients, average age 12.52 years). Patients’
flow data were compared with the previously published flow
data obtained in heathy control (average age, 13.58 years) at
fasting status and after a meal.
Results: As compared to healthy controls, Group 1 (fenestrated
Fontan) showed normal or marginally increased cardiac output
(3.92 ± 0.40 vs 3.72 ± 0.69 L/min/m2, p<0.30), while Groups 3
(completed Fontan) showed decreased cardiac output (3.24 ±
0.71 vs 3.96 ± 0.64 L/min/m2, p=0.003). Both Group 1 and
Group 3 showed reduced abdominal blood flow. Reduced
abdominal flow was mainly due to diversion of a large part of
cardiac output to aortopulmonary collaterals in Group 1 and
reduced cardiac output in Group 3. Superior mesenteric and
portal venous flows were more profoundly reduced in Group 3
than in Group 1. On the contrary, the hepatic arterial flow was
mildly increased in Group 1 and markedly increased in Group 3.
Group 2 showed flow data similar to Group 1 except for the
tendency toward decreased cardiac output and superior vena
caval flow. Hepatic parenchymal changes were more severe in
complete Fontan than in fenestrated Fontan group. There was no
significant correlation between the hepatic flow and imaging
findings.
Conclusions: Fenestrated and completed Fontan circulations
showed distinctly different pattern of flow distribution among
body parts. Further prospective study in a larger cohort is
required to correlate the flow redistribution in Fontan
physiology with imaging and laboratory findings as well as the
long term outcome.
Paper #: 040
Sirolimus treatment for complex lymphatic malformations
in children
Rachelle Durand, DO, [email protected]; Anne Marie
Cahill, Janet R. Reid, MD, FRCPC, Jean Belasco, MD, Sphoorti
Shellikeri, Master's in Biomedical Engineering, Juan S. Calle-
Toro, MD, Abhay Srinivasan, MD; Radiology, Children's
Hospital of Philadelphia, Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Complex lymphatic malformations
can be very extensive and cause significant morbidity. They are
often refractory or not amenable to extant treatment options
such as surgical resection, sclerotherapy and ablation. Sirolimus
acts through the mTOR signaling pathway and may
downregulate cell proliferation and angiogenesis. It is a
promising agent for treatment of vascular anomalies. We assess
the effect of sirolimus on complex lymphatic malformations in
children.
Methods & Materials: This was a retrospective review of
patients administered sirolimus for refractory lymphatic
malformations over a 5 year period. MRI studies performed at
the initiation of therapy and the most recent available study
were reviewed. Lesion volume was measured to determine
change over the treatment period. Tissue composition was also
evaluated for change in fluid content.
Results: Sirolimus (daily dose range 0.18-3.2 mg, mean
duration 24±12 m) was administered to 23 patients, mean age
6±4.9 y (range 0-17 y; 12 female). No serious adverse effects
were encountered. No patients underwent surgery or
sclerotherapy after initiation of sirolimus. The average time
between MR studies was 774±375 d (range 160-1519 d). There
was a significant decrease in lymphatic malformation volume
(p=0.0001), with a mean decrease of 39±25%. Four of 23
patients (17%) saw an apparent increase in lesion size, however
the volume increase was relatively small (median 12%). When
normalized to body mass index, 20/23 patients (87%) showed a
mean 44% reduction in lesion volume. There was no correlation
between percent volume decrease and age, sex or dose duration.
Lesions demonstrated a change in tissue composition (lower
relative fluid content) in 14 patients (64%), while unchanged in
8 patients (36%). Notably, 75% of increasing lesions (3/4) also
had a change in tissue composition, whereas patients with
volume reduction had a composition change in only 39% (7/18,
p<0.005).
Conclusions: Sirolimus therapy produced a significant
reduction in lesion volume and relative fluid content in a
majority of patients, suggesting efficacy in treatment of
complex lymphatic malformations. Our results support
consideration of sirolimus in the treatment of lymphatic
malformations, but additional data that better predict
responders, durability of effect, and long-term adverse effects
would be beneficial in further characterizing its efficacy.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S87
Paper #: 041
Three-dimensional (3D) printed pediatric endovascular
phantom for simulating vascular interventions - A feasibility
study
Sphoorti Shellikeri, Master's in Biomedical Engineering,
Seth Vatsky, [email protected]; Elizabeth Silvestro,
MSE, Sean Trahan, BSE, Abhay Srinivasan, MD, Rachelle
Durand, DO, Raymond Sze, Anne Marie Cahill; Radiology,
Children’s Hospital of Philadelphia, Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To assess the feasibility of
performing multiple complex vascular interventions on an
anatomically accurate 3D-printed pediatric endovascular
phantom.
Methods & Materials: The phantom consists of three anatomic
sections, chest, neck, and thigh with arterial and venous
vasculature created from CT angiography images of 15-year-old
patients. The vasculature was aligned with chest, neck and thigh
regions segmented from CT images of a teenager in Materialise
Mimics and 3-Matic. Rubber tube connections inserted between
the anatomic regions together with pumps simulate circulatory
flow. Vascular access points were created at the neck and thigh
region, covered with a replaceable "skin patch" for reusability.
The vasculature mold and breakaway cavities were 3D printed
on a Stratasys Fortus 450mc in ABS plastic. Smooth-On
Ecoflex 30 silicone was used for molding simulating body
texture and DragonSkin10 used for the skin patches.Three
pediatric interventional radiologists and a trainee successfully
performed the following procedures under fluoroscopic
guidance: renal angiography, cavography, femoral and jugular
supra and infra-renal IVC filter placement and retrieval, non-
target coil embolization and snare retrieval, and iliac stent
placement. Post simulation, all operators completed a
questionnaire, consisting of 13 questions, rating their experience
with the phantom using a 5-point Likert scale (1-Strongly
disagree, 2-Disagree, 3-Neutral, 4-Agree and 5-Strongly agree).
Results: All operators reported that the 3D printed phantom and
vasculature were anatomically accurate, and sheath placement,
catheter/wire manipulation, supra/infrarenal filter placement and
retrieval, and iliac stent placement were realistic. Three
operators reported that the aortography and cavography
compared favorably to live patients. All operators recommended
the 3D printed phantom for basic vascular interventional
training for fellows and for training in complex/infrequent
pediatric vascular interventions for attendings.
Conclusions: To our knowledge this is the first pediatric
endovascular multiuse phantom providing capability of
simulating complex/uncommon procedures in one model with
"soft tissue" consistency. The next iteration will involve
prospective enrollment of IR trainees and formal assessment of
technical skill development with repeatability possible by
replacing anatomic phantom segments (stenting). Initial
feedback from operators validates the importance of the utility
of the 3D printed medical model for training purposes.
Paper #: 042
Percutaneous transluminal angioplasty in children with
Reno vascular hypertension, experience in a tertiary
pediatric institution.
Abhay Srinivasan, MD, [email protected]; Madiha
Aslam, MBBS, Kevin Meyers, MD, Sphoorti Shellikeri,
Master's in Biomedical Engineering, Anne Marie Cahill;
Interventional Radiology, The Children's Hospital of
Philadelphia, Philadelphia,, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Renal artery stenosis is an important
cause of hypertension in children. The aim of this study is to
assess the technical and clinical outcome of percutaneous
transluminal angioplasty in children with RVHN
Methods & Materials: An IRB approved database of patients
undergoing percutaneous renal angioplasty for RVHN was
retrospectively queried. Technical success was defined as the
ability of the angioplasty balloon to cross the stenosis.
Angioplasty success was defined as angiographic improvement
in lesion stenosis per procedure. Clinical patient outcomes were
defined as normal BP off medications, normal BP with reduced
or same medications, no improvement in BP despite technical
success, deterioration in BP and technical failure per patient.
Results: 58 patients diagnosed with RVH underwent 73
percutaneous transluminal angioplasties (28F, 30M), mean age
8.8yrs (1-18yrs), mean weight 37.6kgs (12.8-105kgs).
Diagnoses included; FMD (43), MAS (4), NF-MAS (1) and NF-
1 (10). Technical success was achieved in 67 out of 73
angioplasties (91.7%), 81 of 86 lesions (94.1%). Angiographic
success was achieved in 69 of 73 angioplasties (94.5%);
residual stenosis was <30% in 55/73 (75.3%), 31-50% in 6/73
(8.2%), 51-70% in 5/73 (6.8%) and angiographic failure in 4/73
(5.4%). Mean follow up was 39 months (mode 100m). Clinical
outcome was as follows; normal BP, off medication (cure) in
23/58 patients (40%), normal BP on reduced medications in
18/58 patients (31%), normal BP on same medications in
5/58(8.6%), no improvement in BP despite technical success in
8/58 (13.7%), patient lost to follow up 4/58(6.8%). Cure and
improvement was seen in 35/43 patients (81.3%) with FMD,
7/10 patients (70%) with NF-1, 3/4 patients (75%) with MAS.
Procedure related complication rate was 8.2% (6/73);mild flow
limiting dissection in 1(1.3%), dissection with pseudo aneurysm
in 1(1.3%), Left brachial artery pseudo aneurysm at site of
puncture in 1 (1.3%), segmental branch thrombus with
perfusion defect in 2(2.7%), stable occlusive thrombus in right
common femoral artery in 1(1.3%).Cutting balloon was used
after failure to efface with conventional angioplasty in 20
patients and was successful in 17/20 (85%) patients.
Conclusions: Renal artery angioplasty plays a significant role in
blood pressure modulation in children with renovascular
hypertension. In our experience clinical improvement (normal
BP, off meds and normal BP on reduced meds) was observed in
79.2% patients with cure observed in 40%.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S88
Paper #: 043
Adjunctive Cutting Balloon Angioplasty in Children with
Resistant Renal Artery Stenosis – Experience in a Tertiary
Pediatric
Abhay Srinivasan, MD, [email protected]; Madiha
Aslam, MBBS, Kevin Meyers, MD, Sphoorti Shellikeri,
Master's in Biomedical Engineering, Anne Marie Cahill;
Interventional Radiology, The Children's Hospital of
Philadelphia, Philadelphia,, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Renal artery stenosis in children
tends to have an angiographic pattern similar to intimal
fibroplasia/hyperplasia which can be resistant to conventional
angioplasty. The aim of this study is to assess the outcome of
adjunctive cutting balloon angioplasty in children with RVHN.
Methods & Materials: An IRB approved database of patients
undergoing renal angioplasty for RVHN was retrospectively
queried. The criteria for cutting balloon use was a lack of
response to conventional angioplasty. Technical success was
defined as the ability of the cutting balloon to cross the stenosis.
Angioplasty success was defined as angiographic improvement
in lesion stenosis per procedure. Clinical patient outcomes were
defined as normal BP off medications, normal BP with reduced
or same medications, no improvement in BP despite technical
success, deterioration in BP and technical failure per patient.
Results: Twenty of 58 children diagnosed with RVH
undergoing renal angioplasty were identified as having 25
cutting balloon angioplasty procedures (13M, 7F), mean age
8.3yrs (3-15yrs), mean weight 36.2kgs, (17.5-105kgs).
Diagnoses included; FMD (14), MAS (3) and NF-1 (3).
Technical success was achieved in 21/25 angioplasties (84%)
and 22/25 lesions (88%), 1 lesion having repeat angioplasty.
Angioplasty success was achieved in 23/25 angioplasties (92%);
residual stenosis was <30% in 16/25 (64%), 31-50% in 2/25
(8%), 51-70% in 3/25 (12%) and angiographic failure in 2/25
(8%). All 25 lesions were main renal artery, 9/25 ostial and
16/25 were non ostial. Mean follow up 40 months. Clinical
outcome was as follows; normal BP, off medication in 6/20
patients (30%), normal BP on reduced medications in 11/20
patients (55%) of which 2/11 also had intra parenchymal
disease, no improvement in BP despite technical success in 2/20
(10%), both also having intra parenchymal disease, technical
failure in 1/20 (5%). Procedure related complication rate was
12% (3/25); mild flow limiting dissection in 1(4%), segmental
branch thrombus with perfusion defect in 1(4%), both treated
with systemic heparin and dissection with pseudo aneurysm in
1(4%) treated with coil embolization.
Conclusions: This is the largest series of cutting balloon
angioplasty to date in children with RVH. It can be used as an
adjunctive technique to improve angioplasty response in
children with resistant RAS. Complication rates are not
insignificant and need to be considered.
Paper #: 044
Catheter-directed pharmacologic thrombolysis for acute
submassive and massive pulmonary emboli in children and
adolescents.
Jay Shah, MD, [email protected]; Anne
Gill, MD, Dabin Ji, Wesley Durrence, Kavita Patel, MD, MSc,
Matthew Paden, C. Matthew Hawkins, MD; Interventional
Radiology/Pediatric Radiology, Emory University Hospital /
Children's Hospital of Atlanta, Atlanta, GA
Disclosures: Kavita Patel, MD, MSc: Consultant, Honoraria:
Daiichi Sankyo. All other authors have disclosed no financial
interests, arrangements or affiliations in the context of this
activity.
Purpose or Case Report: The standard of care for pulmonary
embolism (PE) in adults and children is anticoagulation and
systemic intravenous thrombolysis inferring an associated risk
of major hemorrhage. Catheter-directed-thrombolysis (CDT) is
a relatively safe and effective alternative to systemic
thrombolysis in adults with massive/submassive PE while
delivering lower doses of thrombolytics; however, existing
medical literature assessing safety and efficacy of pulmonary
artery (PA) CDT for PE in children is limited.
Methods & Materials: A 16-month retrospective review of
EMR and PACS was performed of patients < 21 years-old who
presented with massive or submassive PE and were treated with
PA-CDT at a tertiary care children’s hospital. Multiple
parameters were analyzed including indications, technical
success, clinical efficacy, and safety of CDT.
Results: Nine-patients (mean 13.9 years-old; range 6-19) with
massive/submassive PE who underwent PA-CDT were
included. PE was diagnosed by CT-angiography and CDT was
technically successful in all cases. At cessation of CDT, follow-
up pulmonary-angiography revealed complete thrombus
resolution in 4-patients, partial resolution in 5-patients. Mean
PA pressures decreased in all patients (mean pre-CDT PA
pressure=36.5 mmHg; mean post-CDT PA pressure=28.0
mmHg). CDT alone was clinically successful in 7-patients
(78%). One-patient with acute-on-chronic PE with severe
pulmonary hypertension required surgical thrombectomy of
chronic-thrombus after CDT of acute-thrombus. One-patient
died following cessation of CDT for reasons unrelated to CDT
procedure. There were no immediate bleeding complications
from CDT therapy. All patients who survived were maintained
on anticoagulation treatment following CDT.
Conclusions: PA-CDT is a technically feasible and relatively
safe therapeutic option for children and adolescents with
submassive and massive pulmonary emboli.
Paper #: 045
Technical feasibility and clinical efficacy of common iliac
vein stenting in adolescent patients with May-Thurner
Syndrome
Frederic Bertino, MD, [email protected]; Anne Gill, MD,
Jay Shah, MD, C. Matthew Hawkins, MD; Radiology and
Imaging Sciences, Division of Interventional Radiology, Emory
University School of Medicine, Atlanta, GA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To define the technical feasibility
and clinical efficacy of common iliac vein stenting in
adolescents with thrombosed and non-thrombosed May-Thurner
syndrome (MTS)
Methods & Materials: IRB approved retrospective review
identified 20 (Female = 13, mean age 15.7 (13-19), mean weight
= 72.4kg) patients who underwent endovascular stenting of the
common iliac vein for symptoms of thrombosed MTS (T-MTS)
and non-thrombosed MTS (NT-MTS) between 2014-2016.
Clinical presentations included NT-MTS (n=3) and T-MTS
(n=17). NT-MTS clinical presentation ranged from lower
extremity swelling, pain, and/or venous congestion. All patients
underwent pre-and-post stent intravascular ultrasound (IVUS)
and venography. All T-MTS had stent placement performed at
the time of pharmacomechanical rheolysis. Catheter directed
thrombolysis with pharmacomechanical rheolysis was
performed in all cases of TMTS. All patients were treated with
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S89
self-expanding stents, ranging from 14-22mm in diameter, and
4-9cm in length. Patients with residual thrombus after
pharmacomechanical thrombolysis were placed on our
institution’s catheter directed thrombolysis protocol using
weight-based dosing of tPA; repeat venography and IVUS were
performed the following day to evaluate for residual clot
burden. Clinical follow up was conducted at 1-6 month time
points. Patients with residual or chronic thrombus or
persistent/recurrent symptoms received follow-up lower
extremity Doppler sonography. All patients with T-MTS were
treated with at least 6 months of anticoagulation by the
hematology service. All patients with NT-MTS were treated
with 6 months of anti-platelet therapy.
Results: Technical success was 100%. Clinical success (defined
as improvement/elimination of symptoms) = 90%. Overall
patency at 6, 12, 18, and 24 months was 100%. No patients had
recurrence of symptoms. One periprocedural complication
included histaminergic reaction to paparavine given for
venospasm.
Conclusions: Endovascular stenting of the common iliac vein in
thrombotic and nonthrombotic MTS is technically feasible and
clinically efficacious with excellent patency and low
complication rates in adolescent patients. Continued
retrospective analysis of patients in our database is ongoing.
Paper #: 046
Split Liver vs Whole Liver OLT: Technical Demands of
Pediatric Portal Vein Recanalization
Heather Cleveland, BSRS, PA-S2, [email protected];
Daniel Ashton1, Alex Chau, MD1, Ryan Himes, MD1, DON R.
TURNEY, BA1, Alberto j. Hernandez1; 1Radiology, Texas
Children's Hospital, Houston, TX, 2Massachusetts General
Hospital Institute of Health Professionals, Boston, MA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Compare technical details and
clinical success of chronically occluded portal vein (PV)
recanalization in pediatric patients with split liver vs whole liver
orthotopic liver transplant (OLT).
Methods & Materials: IRB approval was obtained to
retrospectively review PV recanalization (42 procedures) in 18
OLT patients (12 female) with chronic PV occlusion between
10/2011- 9/2018. Patient demographics, procedure details,
technical and clinical success as well as complications and
follow-up were recorded from chart review.
Results: Technically successful PV recanalization and reduction
of PV pressure gradient to ≤ 5 mmHg was performed in 17/18
patients (94%). Technical success in split liver vs whole liver
was 64% (9/14) and 86% (12/14) in the 28 attempted and
successful recanalization procedures respectively. PV
Recanalization success was higher at first attempt in the whole
liver group (10/12, 83%) in comparison to the split liver group
(3/6, 50%). There was improvement in signs and symptoms of
portal hypertension in 16/18 (89%) patients. Both procedure
time (median: 4.3, range: 2.3-9.9 hours) and fluoroscopy time
(median: 36.9, range: 7.4-153 minutes) were markedly greater
in the split liver group, while the whole liver group was a
median of 3.1 hours (range: 1.4-6.8) and 24.8 minutes (range:
5.2-113.9) respectively. . The procedure time (median: 5.9,
range: 4.3-9.9 hours) and fluoroscopy time (median: 66.1,
range: 38.6-153 minutes) were also both higher in the split liver
group during the time of successful recanalization in
comparison to the whole liver procedure (median:3.5, range:
1.8-6.1 hours) and fluoroscopy time (median:46.9, range: 8.4-
75.5 minutes). Age (median: 3, range: 2-16 years) and weight
(median: 17, range: 13-47 kg) are both reported lower in the
split liver group in comparison to whole liver with median age
of 5 years (range: 1-17) and weight of 28 kg (range: 21-71)
respectively.There were 7 (17%) major complications (SIRC)
total. In split liver vs whole liver there were 4 (20%) and 3
(22%) complications respectively. These included perisplenic
hematoma (n=2), hemoperitoneum (n=4), and hepatic artery
pseudo aneurysm (n=1) managed with pain medication and
blood product replacement. Median follow-up was 17 months
(range: 2-84 months).
Conclusions: Technical challenges requiring longer procedure
and fluoroscopy times could be contingent upon the anatomy of
the patient based on the type of OLT. Though small sample,
technical and clinical success were comparable.
Paper #: 047
Comparison of Modified Single Puncture Technique for
Tunneling Short-term Central Venous Catheter with
Peripherally Inserted Central Catheter in Pediatric Group:
A Preliminary Study.
Yu Jin Kim1, [email protected]; Young Hun Choi2; 1Department of Radiology, Chungbuk National University
Hospital , Cheongju-si, Chungcheongbuk-do, Korea (the
Republic of), 2Seoul National University Hospital, Seoul, Seoul,
Korea (the Republic of)
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Tunneling is known to be less prone
to infection. To compare utility between single puncture
technique for tunneling short-term central venous catheter
targeting internal jugular vein (tunneled C-line) and peripherally
inserted central catheter (PICC) in the pediatric group.
Methods & Materials: From October 2017 to July 2018,
consecutive 32 cases of 25 in-patients (11 boys and 14 girls)
were underwent tunneled C-line or PICC insertion. Both
techniques were performed by a single pediatric radiologist. The
procedure time and catheter lifespan between the two
techniques were compared using the Mann-Whitney test. The
rate of bedside procedure and catheter-related bloodstream
infection (CRBSI) between the two techniques was calculated.
Results: 24 cases (mean age 5 years, range 0-15) of tunneled C-
line insertion and 8 (means age 6 years, range 2-18) cases of
PICC insertion were performed. The procedure time was
significantly shorter in tunneled C-line insertion than PICC
insertion (13±5 min Vs. 19±6 min, p=0.030). The catheter
lifespan showed no significant difference between tunneled C-
line and PICC (12±11 days Vs. 24±21 days, p=0.192). The
bedside procedure was performed for poor patient’s condition in
88% and 0% of cases of tunneled C-line and PICC, respectively.
The rate of CRBSI of tunneled C-line and PICC were 6.7 and
10.6 per 1,000 catheter-days, respectively.
Conclusions: Tunneled C-line was associated with shorter
procedure time, no significant difference in catheter lifespan and
a lower rate of CRBSI compared with PICC. Tunneled C-line
can be an alternative to PICC in severely ill young children at
the bedside.
Paper #: 048
Outcomes of tunneled internal jugular venous catheters in
children younger than 6 months of age
Christopher J. Yen, MD1, [email protected]; Wei Zhang2,
Daniel Ashton2; 1Radiology, Baylor College of Medicine,
Houston, TX, 2Texas Children's Hospital, Houston, TX
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S90
Purpose or Case Report: There is limited data on
complications of central lines in younger infants. The purpose
of this study is to identify factors which may affect
complication rates of tunneled internal jugular (IJ) venous
catheters placed in neonates and infants under 6 months of age.
Methods & Materials: This is a retrospective review of
patients 180 days of age and younger who underwent tunneled
IJ venous catheter placements in the pediatric interventional
radiology department at a single institution over a 4 year period.
Patient demographics, device characteristics, procedural factors,
and clinical follow-up were collected for each catheter placed.
Complication rates, fluoroscopy times, and procedural times
were analyzed based on patient age, weight at time of
placement, side of placement, and technique (single-incision or
conventional). Complication types (line malfunction,
malpositioning, or infection) were analyzed based on duration
of placement and method of resolution.
Results: 146 lines were placed in 128 patients with a total dwell
time of 6,467 line days. A total of 49 complications were
observed which required either replacement over a wire or
removal (total complication rate 33%, or 132 line days per
complication). Complications included 14 infections, 27
malpositioned lines, and 8 line malfunctions. As expected, lines
which ultimately required exchange or removal had a higher
average dwell time compared to lines without complications
(33.2 days vs 66.2 days, p < 0.0001). For dwell times less than
50 days, Cox regression analysis showed a statistically
significant higher rate of complication-free line survival in
patients greater than 5 kg compared to those less than or equal
to 5 kg (hazard ratio 5.12 for <=5kg, p = 0.002). Although not
statistically significant, patients 90 days of age and younger
tended to have higher line survival rates compared to patients
older than 90 days of age (hazard ratios 0.55-0.86). Side of
placement, procedure time, and fluoroscopy time did not have a
statistically significant association with complication rate.
Conclusions: When caring for patients less than 6 months of
age who require tunneled internal jugular venous access,
providers should be aware that dwell time, weight and age may
affect complication risk. Longer dwell times result in greater
risk of complication. In patients weighing less than 5 kg, there is
a higher risk of complication compared to heavier patients for
the first 50 line days. Overall, infants older than 90 days may
have a higher risk of complication.
Paper #: 049
Evaluation of Automated Extraction of Velocity Envelope
for Transcranial Doppler Ultrasound
Justin Baraboo, BS MS1, Rizwan Zafer2, [email protected];
Sherwin S. Chan, MD PhD1; 1Radiology, Children's Mercy
Hospital, Kansas City, MO, 2Kansas City University of
Medicine and Biology, Kansas City, MO
Disclosures: Rizwan Zafer: Financial Interest: Jazz
Pharmaceuticals - Medical advisory board: Consultant;
Sherwin S. Chan: Consultant, Honoraria: Jazz
Pharmaceuticals, Research Grant: GE Healthcare. All other
authors have disclosed no financial interests, arrangements or
affiliations in the context of this activity.
Purpose or Case Report: The purpose of our study was to test
our custom software program’s ability to estimate the blood
flow velocity envelope for transcranial spectral Doppler
ultrasound waveforms.
Methods & Materials: Our group has programmed a custom
algorithm that uses image contrast and neighboring data to
estimate the envelope of a spectral Doppler waveform. Our
algorithm was implemented in java and uses image-based
extraction methods: region of interest reductions, preprocessing,
and a novel envelope extraction technique. To test this method
against industry standards, we performed a retrospective review
on pediatric patients who underwent transcranial Doppler
between 1/1/2008 to 7/15/2017 at a single pediatric center on
Philips IU-22 machines. Ultrasound images of these waveforms
formed three groups: waveforms with manufacturer envelopes,
waveforms with technologist drawn envelopes and waveforms
without envelopes. The manufacturer and manual envelopes
were removed from those images and a human drew the ideal
waveform envelope on each waveform. The average absolute
pixel difference between the human gold standard and another
technique (custom software, manufacturer, and technologist)
was the metric of comparison and was also scaled to the
region’s size. The entire waveform and a single manufacturer
determined wave region were compared across techniques.
Correlation analysis was also performed on the average pixel
error between our algorithm and the manufacturer algorithm for
each waveform.
Results: 230 patients were included with 3810 unique
waveforms. Our approach outperformed the manufacturer or
technologist by average pixel error compared to the gold
standard (p<.01). For entire waveforms, our algorithm was on
average 2 pixels more accurate than the manufacturer; for single
waves, our algorithm was on average 2.9 pixels more accurate
than the manufacturer and 1 pixel more accurate than the
technologist. For entire waveforms unable to be processed by
the manufacturer, our algorithm was on average 18 pixels
different from the gold standard. Error correlation was low
between our approach and manufacturer (r2 <.32). Artifacts and
resizing seemed to have little effect on our technique, with
waveform quality impacting measurement more than artifacts or
scaling.
Conclusions: Our custom algorithm outperforms manufacturer
techniques and technologists’ manual tracing in determining
accurate waveform envelopes for TCD images. This work is a
precursor to using these waveforms for input into machine
learning algorithms.
Paper #: 050
Shear Wave Elastography in Brain Ultrasonography: Initial
Experience and Utility in Detecting White Matter Disease
Alexander M. El-Ali, MD1, [email protected];
Subramanian Subramanian2, Lisa Krofchik, RDMS2, Morie
Kephart, RDMS2, Judy H. Squires, MD2; 1Radiology,
University of Pittsburgh Medical Center, Pittsburgh,
PA, 2Children's Hospital of Pittsburgh, Pittsburgh, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Grayscale and color imaging can
assess a range of intracranial pathology in neonates and young
infants; however, there are recognized limitations in the
evaluation of symmetric bilateral white matter abnormalities.
Early reports suggest that Ultrasound (US) Shear Wave
Elastography (SWE) is a feasible method in neonatal brain
imaging. We describe our initial experience with brain SWE
and report preliminary data suggesting its utility in detecting
white matter disease.
Methods & Materials: SWE has been a part of the standard head
US protocol at our institution since September 2018. SWE
velocity measurements were obtained using a GE Logiq E9
machine with a C1-6 transducer and were recorded in meters
per second (m/s). Regions of Interest (ROI) were placed by an
US technologist with additional measurements by the
supervising doctor, for consistency. In order to establish normal
anatomic stiffness, ROIs were attempted for each patient in the
following areas: periventricular white matter (pWM), lateral
ventricular cerebrospinal fluid, and basal ganglia (thalamus
and/or caudate head). All ROIs were included for analysis.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S91
Statistics were performed in the R software package.
Results: A total of 33 SWE studies were attempted and 22
(67%) were successfully performed. The most common reason
for failure was excessive patient motion. Most patients were less
than 30 days old (n=16, 73%) with an age range of 0-197 days.
All patients were born at >33 weeks gestational age.19 patients
(86%) had normal head ultrasounds or only minor intracranial
pathology that did not affect SWE analysis. 3 patients (14%)
demonstrated significant WM abnormalities including extensive
bilateral venous infarction. SWE demonstrated reliable
differences in mean velocity between the lateral ventricle (0.83
m/s), pWM (1.17 m/s), and basal ganglia (1.56 m/s) (ANOVA,
p<0.001). Direct comparison between pWM and basal ganglia
was also statistically significant (t-test, p<0.001). Mean velocity
for normal pWM (1.17 m/s) significantly differed from
abnormal pWM (2.49 m/s) (t-test, p<0.001). Basal ganglia
measurements did not differ significantly between these groups
(t-test, p = 0.52).
Conclusions: Results from our prospective study demonstrate
that SWE is a feasible technique for evaluation of brain
parenchyma as it can reliably differentiate various normal
intracranial structures. Additionally, our preliminary data
suggest the utility of SWE in the evaluation of white matter
disease.
Paper #: 051
Review of Neck CTA Examinations for Soft Palate Injury
and Proposal of a New Targeted CTA Protocol
Jungwhan J. Choi, MD,
[email protected]; Christiane Burton,
Ph.D., Amy Danehy, M.D., Stephan Voss; Boston Children's
Hospital, Boston, MA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Neck CTA is commonly requested
for patients with soft palate trauma to exclude vascular injury.
Debate exists regarding which imaging studies are indicated in
this setting and standard neck CTA protocols, extending from
thoracic inlet to skull base, result in considerable radiation. The
purpose of this study is to review the yield of neck CTA
following oropharyngeal trauma and to propose a new reduced
dose targeted CTA protocol for this indication.
Methods & Materials: Neck CTA’s obtained between 2008-
2018 for evaluation of soft palate injury were retrospectively
reviewed. Study variables included age; mechanism of injury;
presence of vascular or neurologic injury; and other clinically
significant findings.All CTA exams were performed from the
thoracic inlet to skull base per standard institutional protocol.
Effective dose was estimated using CTDIvol and tissue
weighting conversion factors from ICRP 60 with calculations
based on sagittal reconstructions, using the z-axis of the patient
from skull base to thoracic inlet (full CTA) and to hyoid bone
(targeted CTA) to estimate organs at risk. Dose reduction for the
targeted CTA was defined as the % decrease in effective dose
compared to full CTA.
Results: Between 2008-2018, 98 neck CTA’s were ordered in
the setting of soft palate trauma. Average patient age was 5.1 ±
3.3 yrs. The most common indication was fall with toothbrush
in mouth. 1 study was excluded due to contrast extravasation.No
studies were positive for either neurologic or carotid artery
injury. 1 study was positive for minor small vessel injury.
Clinically significant nonvascular findings were present in 5/97
cases and included: phlegmonous change (n=2); retained
toothbrush foreign body; retropharyngeal/upper mediastinal air;
and nondisplaced medial pterygoid process fracture. With
exception of mediastinal air, all vascular and non-vascular
findings would have been included in a targeted CTA extending
from hyoid bone to skull base.Mean effective dose was 8.63 ±
3.98 mSv per ICRP 60 for standard neck CTA. For the proposed
targeted CTA extending only from skull base to the hyoid bone,
the effective dose estimate was 2.25 ± 0.96 mSv, resulting in
significant dose reduction of 72% ± 8% (p<0.01).
Conclusions: Based on the low yield of routine neck CTA for
evaluation of vascular injury following oropharyngeal trauma, a
new targeted neck CTA protocol is proposed that results in
significantly less dose to the neck, while preserving the
diagnostic yield for both vascular and non-vascular findings.
Paper #: 052
Fissures of the annulus fibrosus and cervical cord anterior
spinal artery infarcts in children: telltale signs of
fibrocarilaginous disc emboli?
Stephen Little, M.D., [email protected]; Damien
Grattan-Smith, MBBS, Susan Palasis, Richard Jones, Andrew
Reisner; Children's Healthcare of Atlanta, Atlanta, GA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To determine if there is an
association between fissures of the annulus fibrosus and anterior
spinal artery (ASA) infarcts of the cervical cord in children.
Methods & Materials: We retrospectively reviewed the sagittal
T2 or STIR images from 145 MRIs of the cervical spine (870
disc levels), including 103 consecutive examinations and 42
examinations performed for acute myelopathy (male 76, female
69; ages 0.2 to 20.7 years). Acute myelopathy patients were
collected from the radiology database using keywords ‘spinal
cord infarct’, ‘transverse myelitis’, ‘acute disseminated
encephalomyelitis’, and ‘neuromyelitis optica’. Images were
transferred to an independent workstation and de-identified.
Masks were placed over the spinal cords to reduce potential
bias. Following a training session, two experienced pediatric
neuroradiologists independently graded the C2-C3 through C7-
T1 discs for annular tear and nuclear degeneration. Six weeks
later, the readers independently reviewed the sagittal T2 or
STIR, axial T2 or STIR and diffusion images (if available) of
the 42 acute myelopathy patients. For this review, masks were
placed over the anterior vertebral column to reduce potential
bias. Patients were classified as ASA infarct, not ASA infarct or
uncertain based on typical imaging characteristics described in
published reports. The frequency of findings and reliability of
observations were calculated.
Results: Cervical anterior spinal artery infarcts were identified
in 7 children (2 male, 5 female) age 3 to 17 years. Type 2
annular fissures were seen in 43-57% of patients with ASA
infarcts, in 3% of myelopathy patients without ASA infarct and
in 2-5% of non-myelopathy patients. Odds ratio for ≥1 type 2 or
3 annular fissure in ASA infarct vs. non ASA infarct was 25.1,
95% CI [2.6, 204.4], p<0.002 for examiner B and 32.0, 95% CI
[4.3, 354.1], p<0.001 for examiner A.
Conclusions: Type 2 annular fissures are associated with
cervical cord ASA infarct in children and are uncommon in
children without ASA infarct (2-5%). Disc dessication is
somewhat more common in children with ASA infarct but is
commonly seen in children without ASA infarct (41-54%).
Interestingly, annular fissures associated with ASA infarct
typically do not enhance at presentation but may develop
enhancement on follow up. Non-enhancing type 2 annular
fissures may be acute and are a potential pathway for
fibrocartilaginous disc emboli to reach the ASA and cord.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S92
Paper #: 053
Clinical benefit of ferumoxytol whole body vascular imaging
including the central nervous system in pediatric patients
Aashim Bhatia, [email protected]; Alexandra Jane
Borst, MD, Jessica Duis, MD, Josephine M. Ndolo, MBChB,
James D. Phillips, MD, Christopher Baron, MD; Vanderbilt
Children's Hospital, Nashville, TN
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Ferumoxytol, an iron oxide
nanoparticle coated by a carbohydrate shell, is increasingly
reported as an off-label blood pool contrast agent for MR
angiography (MRA). We explore the imaging quality and
clinical utility of central nervous system (CNS) and whole-body
vascular MR imaging with ferumoxytol in pediatric patients.
Methods & Materials: Use of ferumoxytol for MRA was
approved by the pharmacy and therapeutics committee. We
retrospectively reviewed all pediatric patients 0-18 years of age
undergoing MRI with ferumoxytol from September 2016-
Sepetember 2018.A blinded radiologist independently scored
imaging quality to determine the results of clinical investigation
using a five-point subjective score, where a score > 3 was
considered diagnostic. The five-point scale was as follows:
1=excellent image quality: no limitations, 2=good image
quality: minimal limitations, 3=sufficient image quality:
moderate limitations, 4=restricted image quality: relevant
limitations, 5=poor image quality: non-diagnostic.
Results: Fourteen children aged 1-17 years of age (mean age
10.7 years) underwent MRA examinations on a 3.0 T MRI after
administration of ferumoxytol at a dose of 3 mg/kg. Whole body
vascular imaging focused on the brain, neck, chest, abdomen,
and selected extremities based on clinical history.In all patients,
the MRI studies were diagnostic with imaging quality
demonstrating excellent signal-to-noise ratio. The average of the
scores was 4.7 (standard deviation of 0.47). Eight of the
fourteen indications were to exclude vascular malformations or
aneurysms. Four studies were performed to evaluate systemic
vasculitides (Takayasu Arteritis and Loeys-Dietz Syndrome).
Two studies were performed for thoracic outlet syndrome. In
multiple cases, findings on MRI with ferumoxytol were
confirmed with biopsy and conventional angiogram. None of
the patients had an adverse reaction to the ferumoxytol.
Conclusions: Ferumoxytol-enhanced MRA is a commonly used
contrast agent at our institution to diagnose vascular
abnormalities in the brain or whole body. Use of ferumoxytol
allows the radiologist to interrogate multiple territories in one
study due to its highly stable intravascular time. We were able
to confidently detect and characterize vascular abnormalities
and exclude vascular malformations. No infusion reactions were
noted in our cohort. Therefore, ferumoxytol is a beneficial and
safe alternative to gadolinium-based contrast agents for high
resolution CNS and whole body MR angiography.
Paper #: 054
Comparison of 2D Turbo-Spin-Echo BLADE and Spin-Echo
Echo-Planar Diffusion Weighted Brain MRI at 3 Tesla:
Preliminary Experience in Children
Aaron S. McAllister, MD1,
[email protected]; Bhavani Selvaraj,
MS1, Lacey J. Lubeley, BS1, Ning Jin, PhD2, Kun Zhou3, Mark
Smith1, Ramkumar Krishnamurthy, PhD1, Houchun Hu, PhD1; 1Radiology, Nationwide Children's Hospital, Columbus, OH, 2Siemens Medical Solutions, Cleveland, OH, 3Siemens
Shenzhen Magnetic Resonance Ltd., Shenzhen, China
Disclosures: Aaron S. McAllister, MD: Equity Interest/Stock
Option: GE, MMM, CHD, JNJ. Ning Jin, PhD: Salary:
Siemens Medical Solutions. Kun Zhou, PhD: Salary: Siemens
Healthineers, Employment. All other authors have disclosed no
financial interests, arrangements or affiliations in the context of
this activity.
Purpose or Case Report: To compare a 2D turbo-spin-echo
(TSE) non-Cartesian BLADE diffusion-weighted MRI with a
conventional SE echo-planar imaging (SE-EPI).
Methods & Materials: All data obtained on a 3T Siemens
clinical scanner. 53 patients (10.4±7.9 years) underwent both
SE-EPI diffusion imaging and the prototype BLADE
sequence.A neuroradiologist evaluated the severity of image
artifacts and whether their presence affected diagnostic image
quality (IQ). The radiologist answered whether BLADE or SE-
EPI was preferred in each case. A 4-point score was given for
each sequence based on the presence of artifacts and signal pile-
up near air tissue interfaces or presence of shunts/orthodontia: 1:
none, 2: mild-diagnostic IQ not affected, 3: moderate-IQ
partially affected, and 4: significant-IQ heavily affected.
Anterior-posterior and right-left dimensions of the brain were
measured at co-registered locations on both DWI sequences and
compared to reference measurements obtained from a 3D T1-
weighted inversion-recovery Cartesian scan.Parameters for SE-
EPI were: 1.5mm resolution, 4mm slices, TR/TE=4100/81ms,
fat suppression, GRAPPAx2 with 40 references lines, partial
Fourier readout, 1446Hz/pixel bandwidth, 0.8ms echo spacing,
an EPI factor=192, four diffusion directions, and two signal
averages for b=0 and three signal averages for b=1000, scan
time ~ 2min. For the prototype BLADE, 1.3mm resolution,
4mm slices, TR/TE=5200/41ms, fat suppression, no GRAPPA
and partial Fourier, no signal averaging, 520Hz/pixel
bandwidth, 11ms echo spacing, EPI factor of 3, and a turbo
factor of 11, scan time ~4min.
Results: In 46% of the cases, BLADE was preferred; in 45% of
the cases, both sequences were preferred equally. Average
scores for SE-EPI was 2.4±0.7 vs. BLADE 1.1±0.3 (p<0.01). In
the A/P direction, the percent geometric distortion varied from -
38.8% to 70.1% for SE-EPI (0.4%±16.4%), whereas for
BLADE it was significantly lower, from -8.6% to 17.5%, while
the average was similar 0.8%±5.12%. However, in the R/L
direction, the distortion varied from -27.5% to 59.5% for SE-
EPI (average: 7.0%±15.7%), whereas for BLADE it was
significantly lower, from -7.6% to 20.9% (1.3%±4.8%).
Overall, SE-EPI exhibited more edge distortions, more signal
pile-up, but had slightly better signal centrally and more
visually pleasing ADC maps than BLADE. Motion artifacts
were minimal on both sequences.
Conclusions: BLADE DWI is feasible in pediatric patients at
3T, and exhibits less distortion near air tissue interfaces and in
the presence of shunts/orthodontia.
Paper #: 055
Evaluation of Highly Accelerated Wave-CAIPI
Susceptibility-Weighted Imaging (SWI) in the Non-Sedated
Pediatric Setting: Initial Clinical Experience
John Conklin, Azadeh Tabari, MD,
[email protected]; Maria Gabriela Figueiro Longo,
MD, Camilo Jaimes, Kawin Setsompop, Steve Cauley, John E
Kirsch, Susie Yie Huang, Otto Rapalino, MD, Michael S.
Gee, Paul A Caruso; Radiology, Massachusetts General
Hospital, Boston, MA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To compare highly accelerated SWI
using Wave Controlled Aliasing in Parallel Imaging (Wave-
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S93
CAIPI SWI) to conventional 3D SWI in the awake pediatric
outpatient clinical setting.
Methods & Materials: This study was IRB approved and
HIPAA compliant. Twenty-three patients (9 girls, 14 boys;
mean age 134.3±55 months, range 1-214 months) underwent
awake outpatient 3T clinical brain MRI (Siemens Healthcare,
Erlangen) using commercially available 32-channel and 20-
channel RF coils. All studies included a conventional 3D SWI
sequence (R=2, acquisition time TA=4.3 minutes) and a highly
accelerated Wave-CAIPI SWI sequence (R=9, TA=1.0 minute
for the 32-channel head coil; R=6, TA=1.5 minutes for the 20-
channel head coil). Two blinded neuroradiologists
independently rated both sequences in terms of artifacts, noise
(central and peripheral), anatomic contrast (ability to delineate
normal structures) and pathologic contrast (ability to delineate
the clinical pathology, when present). The images (standard
SWI and Wave-CAIPI SWI) were anonymized and presented
side-by-side on two adjacent monitors. A predefined 5-points
scale was used, where negative numbers favor standard SWI
and positive numbers favor Wave-CAIPI SWI: 0 indicates that
the sequences were equivalent, -1 or 1 indicates that one
sequence was subjectively preferred but the difference would
not have changed the diagnosis, and -2 or 2 indicates that one
sequence was superior and the difference would impact the
diagnosis. Wilcoxon signed-rank test was used to evaluate the
difference between sequences for each variable.
Results: There were no failed exams (e.g., due to excessive
motion or inability to tolerate scanning). The most common
indications for MRI included tumor, epilepsy, and headache.
Standard and Wave-CAIPI SWI had similar performance for
evaluation of pathologic findings, normal anatomic structures,
noise within the peripheral brain, and artifacts. There was
subjectively more noise within the central brain (n = 15, P
<0.001) using the Wave-SWI sequence, however there were no
cases where this difference would have impacted the final
diagnosis (no scores of +/-2). The inter-reader agreement for
these parameters was moderate to good (kappa 0.45 – 0.75).
Conclusions: Highly accelerated Wave-CAIPI SWI of the brain
is feasible in non-sedated children and can be achieved without
significant impact on overall diagnostic quality. The accelerated
sequence was associated with a subjective increase in central
(but not peripheral) image noise.
Paper #: 056
Comparison of Ultrafast Wave-CAIPI Magnetization-
Prepared Rapid Acquisition Gradient-Echo (Wave-
MPRAGE) and Standard MPRAGE in Non-Sedated
Children:Initial Clinical Experience
Azadeh Tabari, MD, [email protected]; John
Conklin, Maria Gabriela Figueiro Longo, MD, Camilo Jaimes,
Kawin Setsompop, Steve Cauley, John E Kirsch, Susie Yie
Huang, Otto Rapalino, MD, Michael S. Gee, MD, PhD, Paul A
Caruso; Massachussets General Hospital, Boston, MA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: The prolonged scan times of MRI
can be uncomfortable for children, increase the potential for
motion artifacts, limit clinical availability and increase cost.
This study evaluated the feasibility of an ultrafast Wave-
MPRAGE sequence for brain imaging of awake pediatric
patients
Methods & Materials: IRB approved and HIPPA compliant.
Twenty-one patients scheduled for clinical brain MRI were
scanned on a 3T scanner (Siemens Healthcare, Erlangen) using
commercially available 32-channel and 20-channel RF coils. In
addition to the clinical protocol, each MRI included a standard
MPRAGE sequence (R=2, acquisition time TA=5.2 min) and an
ultrafast Wave-MPRAGE sequence (R=9, TA = 1.15 min for
the 32-channel RF coil; R=6, TA=1.75 min for the 20-chanel
RF coil). Pre-contrast (n=8) and post-contrast (n=13) exams
were included. Two blinded neuroradiologists independently
evaluated Wave-MPRAGE and standard MPRAGE in terms of
artifacts, noise (central and peripheral), anatomic contrast
(ability to delineate normal structures) and pathologic contrast
(ability to delineate the clinical pathology, when present). A
predefined 5-points scale was used, where negative numbers
favor standard MPRAGE and positive numbers favor Wave-
MPRAGE: (0) sequences are equivalent, (-1 or 1) one sequence
is subjectively preferred but the difference would not impact the
diagnosis, and (-2 or 2) one sequence is superior and the
difference would impact the diagnosis.Wilcoxon signed-rank
test was used to evaluate the difference between sequences for
each variable
Results: Twenty-one patients (10:11 F:M; mean age 143±48
months, range 1-214 months) were included. The most common
clinical indications were: tumor(9), epilepsy(3),
adrenoleukodystrophy(2), headache(2) and other(5). Wave-
CAIPI MPRAGE provided an 80% reduction in scan time using
the 32-channel coil and a 67% reduction using the 20-channel
coil. Standard MPRAGE was subjectively preferred for
evaluation of normal anatomic findings (18/21). Pathologic
findings and artifacts were similar for both sequences (P>0.05).
Image noise was subjectively increased with Wave-MPRAGE
for both the central and peripheral brain (P<0.01), but there
were no cases (0/21) where this difference would have impacted
the final diagnosis.
Conclusions: Ultrafast brain imaging with Wave-MPRAGE is
feasible in awake pediatric patients, providing a dramatic
reduction in scan time at a cost of subjectively increased image
noise. Diagnostic performance was comparable to standard
MPRAGE in this initial clinical evaluation
Paper #: 057
Bridging vein evaluation in suspected abusive head trauma:
beyond tadpoles and lollipops
Stephen Little, M.D., [email protected]; Damien
Grattan-Smith, MBBS, Richard Jones; Children's Healthcare of
Atlanta, Atlanta, GA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Traumatic subdural hematomas in
abusive head trauma are most often due to bridging vein
disruption. Indeed, the pattern of injured veins may be helpful in
distinguishing minor from major and direct (impact) from
indirect (shaking) trauma. Bridging vein thrombosis (tadpole or
lollipop sign) may accompany acute vein disrupution but can be
difficult to distinguish from extra-axial hemorrhage and may not
be seen if imaging is delayed or in cases of repeated trauma.
Selection and optimization of magnetic resonance venography
(MRV) pulse sequences and post processing techniques is
required for reliable cortical and bridging vein evaluation in
infants and young children.
Methods & Materials: We reviewed 32 MRV examinations in
24 subjects (8 female, 16 male; age 2-44 months, mean 8.5
months, median 5 months). Examinations were perfomed for
suspected abusive head trauma, macrocephaly, vomiting,
infantile spasms, developmental regression and
ventriculomegaly. Techniques included 2D TOF (coronal or
sagittal), 3D PC, contrast enhanced MRV (CE-MRV), CE-MRV
with subtraction and post Gd 2D TOF (axial). Post-processing
techniques included whole volume MIP, whole volume
weighted MIP, volume-rendered and thin slab MIP. Pulse
sequences and post processing techniques providing optimal
visualization of cortical and bridging veins were selected by
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S94
consensus.
Results: First pass contrast enhanced MRV with subtraction
provided the best visualization of cortical and briding veins,
even in infants as young as 2-3 months. 3D phase contrast MRV
was nearly as good, but image quality was scanner dependent.
Sagittal 2D TOF MRV was moderately good at demonstrating
cortical and bridging veins near the sagittal sinus, but suffered
from in-plane flow saturation and poor spatial resolution in
coronal or axial reconstructions. Coronal 2D TOF MRV was the
least desireable for briding vein evaluation. Weighted MIP
images provided the best (and easiest) overall visualization of
the superficial venous system. Thin-slab MIP and volume-
rendered techniques were useful in selected cases.
Conclusions: Selection and optimization of MR venography
pulse sequences and post-processing techniques allows for the
reliable demonstration of cortical and bridging veins in infants
and young children with suspected abusive head trauma.
Improved characterization of bridging vein injury may
distinguish traumatic from atraumatic SDH and provide
valuable insight into the nature and magnitude of head injury.
Paper #: 058
Facial hemangioma: risk of PHACE syndrome and
associated anomalies.
Maïa Proisy, M.D1, [email protected]; Frederic
Thomas-Chausse, MD1, Julie Powell, MD2, Francoise Rypens,
MD1, Chantale Lapierre, MD1, Josée Dubois, MD1; 1CHU
Sainte-Justine, Medical Imaging Department, Montreal,
Quebec, Canada, 2CHU Sainte-Justine, Department of
Pediatrics, Montreal, Quebec, Canada
Disclosures: Maïa Proisy, M.D.: Research Grants: Société
Francaise de Radiologie, Région Bretagne (France). All other
authors have disclosed no financial interests, arrangements or
affiliations in the context of this activity.
Purpose or Case Report: PHACE syndrome is defined as a
large segmental infantile hemangioma (IH) larger than 5 cm,
posterior fossa malformations, cerebral arterial anomalies, aortic
coarctation, eye anomalies and sternal defect. Cerebrovascular
anomalies are estimated at 55% and cardiovascular anomalies at
42%. Cerebral artery anomalies were reported to be on the same
side as the facial IH. The objective of our study is to review
facial hemangioma and the risk of cerebral or cardiovascular
anomalies in PHACE or non-PHACE patients.
Methods & Materials: We reviewed all patients seen in our
vascular anomalies group with the diagnosis of facial IH and
who have clinical photos and MRI. The clinical photos were
reviewed to determine the localization of the lesion by segment
and the right or left lateralization. Cerebrovascular, posterior
fossa or cerebral anomalies were reviewed. The presence of
cardiovascular anomalies, sternal defect, eye anomalies or
intracranial hemangioma was recorded. Two experienced
paediatric radiologists scored brain MRI. Clinical data was
reviewed by dermatologists using the consensus statement on
diagnostic criteria for PHACE syndrome.
Results: One hundred twenty-six children (93 girls and 33 boys,
mean age 16.8 months) with facial hemangioma and brain MRI
scan were included. Twenty-one patients out of 126 had
PHACE syndrome. Thirty-eight (30%) children had a segmental
hemangioma larger than 5 cm and 88 (70%) smaller than 5 cm.
Cerebrovascular anomalies were seen in 18/126 (14%). Of
them, 17/18 (94%) were PHACE. Brain anomalies were seen in
9/21 PHACE patients (42%) whereas only one non-PHACE
patient had brain anomalies (p<0.001). Seventeen of 38 patients
with hemangioma larger than 5 cm had an associated
cerebrovascular anomaly whereas only one patient with a
hemangioma smaller than 5 cm had cerebrovascular anomaly
(p<0.001). Eight of those 38 patients (30%) had associated brain
anomalies whereas only 2 patients with hemangioma of less
than 5 cm had associated brain anomalies (p<0.001). The
laterality of the cutaneous hemangioma and the underlying
cerebrovascular anomalies was concordant in 61% (11/18).
Cardiovascular anomalies were seen in 6 patients and ocular
anomalies in 8 patients. All of them had a PHACE syndrome.
Conclusions: In patient with facial segmental hemangioma of
more than 5 cm, brain MR, MRA and cardiovascular MR have
to be performed. The ipsilaterality of the cerebrovascular
anomalies was seen in only 61% of our cases. Long-term
follow-up is recommended.
Paper #: 059
Validation of Automated Analysis of Bone Age from Hand
Radiograph
Jonathan Bowden, [email protected]; Sasigarn
Bowden, Brent Adler, MD, Houchun Hu, PhD, Rajesh
Krishnamurthy, Ramkumar Krishnamurthy, PhD; Radiology,
Nationwide Children's Hospital, Columbus, OH
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Bone Age (BA) is the measurement
of the skeletal maturity of an individual using hand radiograph.
Manual BA assessment, performed by a trained radiologist, is
the current gold standard and has high inter observer variability
(IOV). BoneXpert is an automated machine learning algorithm
(software) with zero IOV, and generates results in 5 seconds.
The aims of this study are to compare the BA analysis by
BoneXpert with the radiologists’ manual readings in a cross-
sectional cohort, as well as a longitudinal cohort. manual
readings.
Methods & Materials: A total of 614 BA studies from 473
patients, assessed by three radiologists from 2013-2018 were
identified for automatic determination of BA by BoneXpert
(Visiana, Holte, Denmark). BA readings by BoneXpert were
compared with those by radiologists’ manual readings based on
the Greulich and Pyle Method. Spearman’s correlation
coefficients were used to assess the association between
BoneXpert and manual readings.
Results: A total of 583 BA studies were included in the cross-
sectional analysis comparing the manual readings and the
BoneXpert’s assessment. BA data from a subset of 119 patients
that had two or more BA studies were analyzed for a
longitudinal study to compare the change in skeletal maturation
between these 2 methods. BA analyses by BoneXpert and
manual reports showed a strong correlation (r = .9786; P <
0.0001) with the mean difference of BA between these 2
methods being 0.12 ± 0.76 years. When stratified to male and
females groups, BA analyses by BoneXpert and manual method
remained strongly correlated (P<0.0001) in each gender group.
In the longitudinal study, there was also a strong correlation
between BoneXpert and manual readings (r = .7852; P < 0.01).
Conclusions: BoneXpert can analyze the hand radiographs
quickly and effectively, and produce a BA assessment that is
comparable to the manual readings. Other future research will
determine the clinical utility of Bone Health Index assessed by
radiogrammetry of BoneXpert and how it is correlated with
bone density measurement and bone health in pediatric patients
with various metabolic bone disorders.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S95
Paper #: 060
Multi-institutional Implementation of an Automated Tool to
Predict Pediatric Skeletal Bone Age: How We Did It
Nishith Khandwala1, [email protected]; David Eng1, Sarah
S. Milla, MD2, Nadja Kadom, MD2, Naomi Strubel3, Shailee
Lala3, Nancy Fefferman3, Ross Filice4, Sanjay P. Prabhu,
MBBS, FRCR5, Michael L. Francavilla, MD6, Summer Kaplan,
MD MS6, Susan E. Sharp, MD7, Alexander J. Towbin, MD7,
Mac Everist8, Neville Irani8, Safwan Halabi, MD1; 1Radiology,
Stanford University, Stanford, CA, 2Emory University, Atlanta,
GA,3NYU Langone Health, New York, NY, 4MedStar
Georgetown University Hospital, District of Columbia,
DC, 5Boston Children's Hospital, Boston, MA, 6Children's
Hospital of Philadelphia, Philadelphia, PA, 7Cincinnati
Children's Hospital and Medical Center, Cincinnati, OH, 8University of Kansas Health System, Kansas City, KS
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Skeletal bone age assessment is a
common clinical practice to investigate endocrinology, genetic
and growth disorders of children. Clinical interpretation and
bone age analyses are time-consuming, labor intensive and often
subject to inter-observer variability. Bone age prediction models
developed with deep learning methodologies can be leveraged
to automate bone age interpretation and reporting. The bone age
model developed at our institution was offered to interested
health systems and institutions to implement and validate the
model. This study discusses the logistical, technical, and clinical
issues encountered with this model implementation.
Methods & Materials: After IRB approval, multiple U.S. based
radiology departments were solicited to adopt and validate the
Stanford University bone age model. A total of 8 institutions (4
standalone pediatric hospitals and 4 academic radiology
departments) agreed to partner with the primary investigators.
IRBs at each institution were required in addition to registration
with ClinicalTrials.gov registry. Standardization of the data use
agreements was performed. Patient data and protected health
information data was retained at each institution. Technical
requirements included model hosting at each institution and
integration to send images to the model server and results to the
interpreting radiologists.
Results: Multiple logistical, technical, and clinical issues were
encountered. IRBs at the various institutions had different
requirements including waiving patient consent. Technical
differences between institutions included model hosting, PACS
integrations, interfaces with the reporting system, and image
preprocessing. Clinical differences included report templates,
calculation of bone age standard deviation, use of Brush
foundation, and ability to directly send bone predictions to the
reporting system (versus displaying the results as a separate
interface). The bone age model was successfully implemented at
7 institutions and approximately 190 studies have been
evaluated.
Conclusions: There are myriad challenges to implementing and
validating models developed with deep learning methodologies.
As models are developed for various clinical use cases including
bone age assessment, it will be incumbent on radiology
practices and health information systems to integrate these
models into clinical practice.
Paper #: 061
Cross-validation of two Convolutional Neural Networks for
radiographic fracture detection
Zbigniew A. Starosolski, PhD,
[email protected]; J. H. Kan, MD, Ananth
Annapragada; Pediatric Radiology, Texas Childern's Hospital,
Houston, TX
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: We evaluate the hypothesis that
Convolutional Neural Networks (CNNs) well-trained for
detection of a certain class of fractures can be cross-applied to a
different class of fractures and long bone anatomy in children.
We tested a network trained for detection of acute distal tibia
fractures (CNN-DTF) on generalized long bone fractures of the
upper and lower extremity (CNN-LBF) and conversely, a CNN-
LBF network on only tibial fractures.
Methods & Materials: Both CNNs (CNN-DTF and CNN-LBF)
were based on the Xception network with additional five fully
convoluted reasoning layers and a drop-off layer. Network
training was performed with 50/50 class balance of positive and
negative exams. CNN-DTF (mean age 6.4 years, male 54.6%)
was trained on 980 radiographs of acute distal tibia fractures
with accuracy of 97.8% for detection of DTF. CNN-LBF (mean
age 8.6 years, male 58.2%) was trained on 521,000 patches
generated from 1444 long bone radiographs of fractures that
included both upper and lower extremities with an 86%
accuracy for detection of LBF. These networks were then cross
applied and their accuracy measured.
Results: CNN-DTF which was trained to find nondisplaced
distal tibial fractures only, had an accuracy 58.5%, sensitivity
92.9%, specificity 24.2 % in identifying any acute fracture when
given a mixture of pediatric upper and lower extremity multi-
orthogonal long bone radiographs (correct identification of
29721/32000 positive exams, correct identification of
7730/32000 negative exams). CNN-DTF algorithm was unable
to correctly differentiate normal physes and apophyses, as well
as overlaying bones of the forearm from pathology. CNN-LBF
trained to find fractures in any pediatric upper and lower
extremity long bones, had an accuracy 66.7%, sensitivity
43.4%, specificity 89.8% in identifying any pediatric acute tibia
fracture (correct identification of 145/256 positive exams,
correct identification of 26/256 negative exams). CNN-LBF was
not able to find small nondisplaced fractures and buckle type
fractures typical in distal tibia fractures in younger children,
resulting in a high false negative rate.
Conclusions: Both networks undergo a loss of accuracy when
utilized for fracture identification of anatomy that they were not
trained to evaluate. These results show the importance of proper
utilizing anatomy specific training sets which is a significant
limitation of current CNN’s.
Paper #: 062
Improved accuracy for tibial fracture identification by a
convolutional neural network and transfer learning
Zbigniew A. Starosolski, PhD,
[email protected]; J. H. Kan, MD, Ananth
Annapragada; Pediatric Radiology, Texas Childern's Hospital,
Houston, TX
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: CNN’s trained for automated
radiologic imaging interpretation using large datasets are highly
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S96
accurate. However, such large training sets are often not
available. The purpose of this study is to determine whether a
partly pre-trained CNN network with a limited number of
specific cases may achieve high accuracy for tibial fractures.
Methods & Materials: An extended text search within the
electronic medical records at a children’s hospital was
performed on all radiographic exams conducted between 2009
and 2017 with 490 acute tibial fractures and 490 normal leg
exams with a total of 2118 radiographs (mean age 6.4 years,
with 54.6% boys). All images were cropped to a standard size of
299x299 pixels and rotated to a standard orientation. The
images were then randomly divided into a training
set/validation-set/test-set in an approximately 80/10/10 ratio:
The training set contained 784 images, while the Validation set
and the Test set each included 98 images. A pre-trained CNN
with 136 layers was augmented with an additional two segments
with fully convoluted reasoning layers and a drop-off layer for
robust feature preservation. After training, a test set containing
49 radiographs with fractures and 49 without fractures was
classified by the CNN. Both the test and training set contained
leg radiographs in multiple orthogonal views (AP, oblique, and
lateral).
Results: CNN automated radiologic interpretation correctly
classified 47 of the 49 positive radiographs, and correctly
identified the 49 normal radiographs, corresponding to
sensitivity, specificity, and accuracy of 95.9%, 100%, and
97.8%, respectively. There were no false positive studies.
Retrospective examination of the 2/49 false negative results
were subtle fractures that would had probably been missed by
most radiologists.
Conclusions: Our feasibility study on the use of CNN for CAD
of tibial fractures has the promise to automate and improve
workflow for radiologists. Our partly-trained CNN network
using a limited dataset, similar to the numbers a typical
radiology trainee will see, was robust and able to multi-
orthogonally identify fractures and distinguish these fractures
from normal physes. This pilot exam on tibial fractures will
serve as a basis and foundation for future CNN training for long
bone fractures elsewhere in the skeletally immature child.
Paper #: 063
Improved accuracy for recognition of pediatric long-bone
fractures in the setting of variable open growth plates by
Convolutional Neural Networks
Zbigniew A. Starosolski, PhD,
[email protected]; J. H. Kan, MD, Ananth
Annapragada; Pediatric Radiology, Texas Childern's Hospital,
Houston, TX
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Convolutional neural networks
(CNNs) show promise for automatic facilitated radiologic
diagnosis. Fracture morphology heterogeneity in the setting of
skeletal immaturity with variable appearances of physes and
apophyses are a challenge for traditional automatic
classification techniques. The purpose of this study was to
evaluate the effect of CNN architecture and training set
generation methods on the accuracy of computer-aided
diagnosis (CAD) of upper and lower extremity long-bone
fractures in children.
Methods & Materials: This IRB approved study was
performed with a dataset obtained at a children's hospital from
2015-18 that included 1444 pediatric acute fractures and 1147
normal radiograph of the upper and lower extremity long bones
(mean age 8.6 years, 58.2% male). Abnormal exams with casts,
implants, healing, or other pathology were excluded. Fracture
locations were recorded in image coordinates for further dataset
generation. Radiographs were patched into 512x512 image sets
from the raw DICOM images. Patches were randomly generated
in an automated fashion. Training set including 512000 patches
was created with 50/50 fracture-to-normal ratio. The validation
set and test set each had 64000 images with exact class balance.
The previously trained Xception network was chosen for this
task due to its high overall accuracy for image classification. A
transfer learning approach with five additional fully connected
layers on the top of the Xception network and one drop-off layer
for robust feature preservation, was used for the classification
task. To further improve the classification, the classification
threshold - the critical value that divides positive form negative
predictions was optimized.
Results: A classification threshold of 0.2 was selected to
minimize false negative results. The CNN correctly classified
27816 of the 32000 fracture cases and 27603 of the 32000
normal cases, corresponding to sensitivity, specificity, and
accuracy of 86.93%, 86.62%, and 86.6%, respectively. The area
under ROC curve was 0.93
Conclusions: Acute pediatric long bone fracture identification
is possible with high accuracy using an automated patch
approach with well parameterized CNN’s using transfer
learning. The automated patch approach eliminates image
scaling and allows localization of the classified fracture within a
relatively narrow spatial domain. Our optimized CNN performs
similarly to adult long bone fracture algorithms despite the
presence of variable growth plates in the skeletally immature
child.
Paper #: 064
Underappreciated Elbow Fractures: Pediatric Radial Head
and Neck Fractures and Additional Fracture Associations
Andrew J. Degnan, MD, MPhil, [email protected];
Victor Ho-Fung, MD, Jie C. Nguyen, John T. Lawrence,
Summer Kaplan, MD MS; Radiology, Children's Hospital of
Philadelphia, Philadelphia, PA
Disclosures: John T. Lawrence: Royalty: Sawbones. All other
authors have disclosed no financial interests, arrangements or
affiliations in the context of this activity.
Purpose or Case Report: Radial head and neck fractures
represent a small fraction of all pediatric elbow fractures but are
often associated with significant long-term morbidity. Various
mechanisms can cause these radius fractures; however, the
constellation of associated injuries is poorly understood in the
pediatric population. The goal of this study is to assess the
frequency of additional fractures in the setting of proximal
radial head and neck fractures.
Methods & Materials: This IRB-approved study reviewed 600
consecutive cases with reports suggesting a proximal radius
fracture obtained during a five-year period (2013-2017).
Pathologic and non-radial head or neck fractures were excluded.
Initial and follow-up radiographs were re-reviewed to assess the
presence and type of fracture as well as the presence of elbow
joint effusion on initial presentation. Fracture types and
properties were analyzed using ANOVA and independent
samples t-tests.
Results: 334 radial head and neck fractures were identified
(50% female; mean age: 9.6 years, SD 3.9). 37% were noted to
have one or more additional fracture about the elbow.
Olecranon fractures were most common (23% of all cases),
followed by additional medial epicondyle fractures (4%),
coronoid fractures (3%), ulnar diaphyseal fractures (3%), and
olecranon with medial epicondyle fractures (2%) and others (1-
2%). Approximately one-third (33%) of additional fractures
were missed by the initial interpreting radiologist. Most (68%)
of the missed fractures were visible on the initial radiographs,
but 32% were only visible on follow-up radiographs because of
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S97
a healing response.Presence of a complete fracture (OR: 2.6,
CI:1.6-4.1, p<0.001) and joint effusion (OR: 2.2, CI:1.2-4.0,
p<0.001) both increased the likelihood of secondary fracture.
Isolated radius fractures occurred in older patients compared
with those with additional associated fractures (mean age: 9.3
years, SD 3.9 vs. 7.6 years, SD 3.6; p<0.001).
Conclusions: Proximal radius fractures are often associated
with additional fractures, most commonly olecranon fractures.
These additional fractures are frequently missed. Presence of
joint effusion and complete radius fracture may suggest greater
likelihood of an additional elbow fracture and prompt additional
investigation.
Paper #: 065
Utilizing 3D-Printed Models to Optimize Digital
Tomosynthesis for Pediatric Medial Epicondyle Elbow
Fractures
Emily A. Edwards, [email protected]; Kristin S.
Livingston, MD, Michael Griffith, RT, Andrew Phelps, MD,
Jesse Courtier, MD, John D. MacKenzie, MD, Matthew A.
Zapala, MD, PhD; Radiology and Biomedical Imaging,
University of California, San Francisco, San Francisco, CA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Pediatric elbow fractures rely heavily
on imaging for clinical evaluation and determination of
operative versus non-operative management, specifically for
medial epicondyle fractures. Standard radiographic views are
often suboptimal for visualizing maximal medial epicondyle
displacement, and orthopedic surgeons may require elbow
computed tomography (CT) for definitive characterization.
Digital tomosynthesis (DT) is an imaging technique that creates
multiple radiographs with high in-plane resolution. The
hypothesis of this study is that DT can assess displacement of
medial epicondyle fractures with similar accuracy to CT and
lower radiation dose. Radiopaque 3D-printed models were used
to optimize positioning and DT technique.
Methods & Materials: Three 3D-printed models were
generated based on CT data of pediatric patients with medial
epicondyle fractures using at least 20% polylactic acid fill. DT
was performed in thirteen projections/sweeps to determine
optimal visualization of fracture fragment displacement. Two
pediatric radiologists independently reviewed all
projections/sweeps and measured maximal displacement. CT of
the 3D-printed models was performed as the gold standard with
consensus agreement by the two radiologists on maximal
displacement. Estimated radiation dose for pediatric elbow DT
was calculated using phantoms. Non-contrast upper extremity
CT dose estimates were extracted from dose reports at the
authors’ institution between July 1, 2015 and June 30, 2018
(N=52).
Results: Absorbed dose estimates for DT were 0.15-0.21 mGy,
compared to 0.02-0.04 mGy for 2-view elbow radiographs and
median CT upper extremity dose 3.9 mGy. Six projections were
excluded for poor fracture visualization and inter-reader
measurement variation >1 mm. The remaining seven projections
had good inter-reader agreement (both readers <1 mm variance
from each other, Pearson coefficient 0.93). The lateral
transverse and oblique longitudinal DT projections were closest
to consensus CT maximal displacement (2.9 and 3.4%
measurement variance from CT, respectively).
Conclusions: 3D-printed models help to optimize DT technique
for ideal visualization of displacement of pediatric medial
epicondyle fractures. The lateral transverse and oblique
longitudinal DT projections had high inter-reader agreement and
high correlation with CT measurement of fracture displacement,
at approximately 1/20th the absorbed radiation dose.
Paper #: 066
Long Bone Growth and Skeletal Maturation Patterns of
Children with Progeria
Andy Tsai, MD, PhD1, [email protected];
Patrick Johnston, MMath, Msc1, Michele Walters, MD1, Leslie
Gordon, MD, PhD2, Monica Kleinman, M.D.1, Tal Laor, MD1;
Boston Children’s Hospital, Boston, MA, 2Rhode Island
Hospital, Providence, RI
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Hutchinson Gilford progeria
syndrome (HGPS or Progeria) is a rare sporadic genetic disorder
(1 in 20 million) that uniformly is fatal, with most deaths
attributed to myocardial infarction between 7-21 years of age.
Due to the disease rarity and short patient life-span, there are
only ~400 children with Progeria alive worldwide at any given
time. One early clinical manifestation in Progeria is abnormal
skeletal growth, yet this has not been fully characterized. The
objective of this study is to characterize the longitudinal long
bone growth and skeletal maturation pattern of children with
Progeria.
Methods & Materials: Skeletal survey radiographs of children
with Progeria performed at a large tertiary hospital (1/1/2009-
7/31/2018) were reviewed. The protocol for the surveys varied
over time, but the majority included PA radiographs of the left
hand/wrist, and AP radiographs of each humerus, radius, ulna,
tibia, and fibula. No femur radiographs were obtained. Using
the left hand/wrist radiographs, bone ages of these children were
estimated by the standards of Greulich and Pyle. Following
methodology established in the literature for studying long bone
growth, the study cohort was separated into 2 overlapping age
groups: childhood (≤12 years-old) and adolescence (≥10 years-
old). For those in the childhood cohort, bone length
measurements were made between physes along the midline
long axis of the bone. For those in the adolescence cohort, bone
length measurements were made along the midline long axis of
the bone from the upper margins of the proximal to the lower
margin of the distal ossified epiphyses. These long bone length
measurements (humerus, radius, ulna, tibia, and fibula) and
bone age estimates were plotted against patient chronologic
ages and compared to published normal reference standards.
Results: Eighty-six children (M:F=46:40) with 253 skeletal
surveys (M:F=121:132; age range=2 months-22 years) were
included. Bone age estimates showed a skeletal maturation
pattern that is comparable to normal. However, longitudinal
long bone lengths from these children began to significantly
deviate from normal by age 1-2. The growth curves of these
long bones plateau at around age 10. At adulthood, long bone
lengths ranged from 48-61% of normal.
Conclusions: Our study establishes reference standards for long
bone growth and skeletal maturation of children with Progeria.
These 2 outcome measures may offer objective assessments to
evaluate the efficacy and response of these children undergoing
treatment.
Paper #: 067
Can Ultrasound be reliably used to evaluate infants with
DDH after age 6 months without the use of plain film
radiography?
Noor M. Maza, BS1, [email protected]; Stanley
Ewala1, Christopher Ferrer1, Abigail Allen, MD2, Sheena
Ranade, MD2, Joy Masseaux, MD2, Henrietta K. Rosenberg,
MD, FACR, FAAP2; 1Icahn School of Medicine, New York,
NY, 2Mount Sinai Hospital, New York, NY
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S98
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: DDH occurs in 1.5/1000 births and
requires prompt diagnosis and treatment as well as interval
clinical and imaging surveillance for assessment of healing and
complications. Current screening and monitoring guidelines
recommend the use of US for evaluation of the hip in infants <6
months of age, and XR imaging in patients >6 months. The
purpose of this study is to determine whether US is a reliable
surrogate for XR for evaluation for DDH in patients >6 months.
Methods & Materials: This is an IRB approved retrospective
study of a series of 22 at risk patients >6 months of age who had
both US and XR for assessment of DDH. All of the imaging
studies of potential patients were reviewed by 1-2 experienced
pediatric radiologists with all the studies having been performed
by an experienced pediatric radiologist. 30 patients >6 months
were identified who had both US and XR studies of which 8
patients with a time difference between modalities greater than
4 months were excluded. Dynamic hip US was performed
(transverse flexion and longitudinal flexion views without stress
and with stress and during the Ortolani maneuver were
obtained; Graf angles measured), except when patient was in a
Pavlik harness or brace at which time adynamic hip sonography
was performed. When it was determined that alignment was
normal without stress, dynamic hip US was added. Size,
configuration, and symmetry of the femoral capital epiphyseal
ossification centers was assessed when present. All of the
studies were performed using Philips IU22 US units (L12-5
and/or L9-3 probes with a few of the earlier images obtained
with a C5-2 or 9-4 probe). The US reports included descriptions
of the hip morphology (including Graf angles), alignment, and
stability. AP supine XR included either a neutral projection or
both neutral and frog lateral views. The shape of the
acetabulum, alignment of the hips, and the presence, size and
symmetry of the femoral capital epiphyses was assessed, and
the acetabular angles were measured on neutral views.
Alignment was also assessed on frog lateral views.
Results: In all 22 patients, there was excellent correlation
between the US and XR finding.
Conclusions: US may be used as a first line imaging modality
in babies >6 months of age presenting with clinical suspicion of
DDH as well as those who were diagnosed with DDH prior to 6
months and are due for follow up surveillance, as long as the
operator is appropriately experienced and the probe technology
allows for visualization of all pertinent landmarks.
Paper #: 068
Outcomes Measures Related to Care Process Models in the
Evaluation of Infants for Developmental Dysplasia of the
Hips
Jeffrey Prince, MD,[email protected]; Department of
Medical Imaging, Primary Children's Hospital, Salt Lake City,
UT
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Care process models (CPM) give
guidance for the use of imaging in clinical scenarios and can be
effective in screening processes.A CPM needs to be supported
by and modified based on outcomes measures. We evaluate 2
CPM's associated with screening for developmental dysplasia of
the hip (DDH) in infants to see if the outcomes measures
support or improve the CPM. One model gives guidance
regarding timing of initial ultrasound evaluation for possible
DDH in an attempt to avoid multiple ultrasound studies as part
of the evaluation. The second model involves the methods used
in evaluated patients with a breech risk factor for DDH.
Methods & Materials: All patients evaluated with ultrasound
for possible DDH in a 27 month period were retrospectively
reviewed. Age at the first ultrasound exam, result of that exam,
number of follow-up exams, referral to orthopedics, and
ultimate outcome for the patient were recorded. Additionally in
patients evaluated because of breech presentation, the use of a
follow-up radiograph between 6 and 12 months of age and the
outcome of that study was also recorded.
Results: Over the review period, 1830 patients were evaluated
for the possibility of DDH. 143 were diagnosed with DDH.
1289 were felt to be normal. 398 were placed in an immature
category. Immature categorization was given in 38.4% of
patients under the age of 6 weeks at initial evaluation, in 29.4%
of patients between the ages of 6 and 7 weeks, and in 7.3% of
patients at 8 weeks of age or greater. Patients in the immature
category required on average 0.92 additional ultrasound
examinations. 97.9% of immature patients normalized without
therapy.592 were evaluated initially because of breech
presentation as a risk factor over a one year period. 203 of these
patients had a follow-up radiograph as part of their evaluation as
was recommended in the CPM. 98.0% of these patients were
normal at the time of the radiograph. 12 patients were referred
to orthopedics because of an abnormal radiograph. 4 of these
required therapy and 8 were observed and remained normal
clinically.
Conclusions: Outcomes measures support the recommendation
that an initial hip ultrasound for risk factors should not be
performed until the patient is 6 weeks of age. If this
recommendation had been followed, 111 unnecessary
ultrasound examinations could have been avoided. Outcomes
measures do not support the recommendation of a follow-up
radiograph for patients screened for a risk factor of breech
presentation. These patients rarely develop hip dysplasia.
Paper #: 069
Comparative dose and image quality evaluation for scoliosis
follow-up exams: assessment of standard and low-dose
modes of a slot-scan radiographic system
Sébastien Benali, MD, [email protected];
Sylvain Deschenes, Ph.D., Stefan Parent, MD, Marjolaine Roy-
Beaudry, Veronika Syzonenko, Josée Dubois, MD; Medical
Imaging, CHU Sainte-Justine, Montreal, Quebec, Canada
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: We compare standard and low-dose
modes of an X-Ray slot-scanner through a wide-ranging
evaluation of dose and image quality for scoliosis exams.
Methods & Materials: The EOSTM slot-scanner is a bi-planar
system that can acquire simultaneously two orthogonal x-ray
images. The patient is scanned vertically by fan beams coupled
with linear gaseous detectors. The system offers high quality
images using radiation dose several times lower than DR due to
a better management of scatter radiation.Recently, a new low
dose mode was introduced for the system. The goal is to offer
images of diagnostic quality using less radiation dose. This is
achieved by lowering the tube tension and current while
applying adapted image post-processing.In this work, we
compare images acquired on 28 pediatric patients and their
respective dose. Patients underwent two scoliosis follow-up
examinations, both consisting in the acquisition of lateral and
posteroanterior x-ray images, once with standard dose
parameters and once in low-dose mode. Dose-Area product for
each examination was collected and OSL dosimeters were
placed near radiosensitive regions on the patient before each
scan. Two radiologists evaluated the images in a randomized
order using a questionnaire targeting anatomic landmarks.
Visibility of the structures was rated on a 4 degrees scale. Image
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S99
quality assessment was analyzed using a Wilcoxon signed ranks
test.
Results: Dose-Area Products show decrease in dose ranging
from 3 to 5 times when imaging in low-dose mode. These
reductions are consistent with direct measurements obtained
with OSL.All images meet diagnostic quality standards.
Assessment of global image quality and visibility of a large
majority of musculoskeletal landmarks showed no statistically
significant bias when comparing standard and low-dose images.
Few landmarks, such as femoral heads in lateral view, were
better seen in standard mode (p=0.013), while other, like
cervicothoracic junction in posteroanterior view, scored better
in low-dose mode (p=0.002).
Conclusions: We established that the low-dose mode offers
diagnostic image quality while decreasing drastically the dose to
the patient.This dose reduction is crucial for scoliosis follow-
ups since they involve repeated X-rays that can increase the risk
of detrimental effects due to ionizing radiation.
Paper #: 070
Comparing Image Quality and Exposure Rates Between
Flat Panel Detectors and Image Intensifiers in Fluoroscopy
Elizabeth Snyder, MD, [email protected]; Marta
Hernanz-Schulman, MD, Kenneth Lewis, Diana Carver;
Vanderbilt University Medical Center, Nashville, TN
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Flat panel detectors (FPD) have
increasingly replaced image intensifiers (IIs) with the aim of
providing high image quality and potentially lower patient
radiation doses. As limiting radiation exposure is particularly
important in our pediatric patients, our objective was to
compare exposure rates and image quality between FPD and II
fluoroscopes.
Methods & Materials: Exposure rates were measured for the
FPD in both medium- and low-dose modes and for the II in low-
dose mode at three magnification levels for both continuous and
pulsed fluoroscopy at 7.5 frames/sec. All measurements were
recorded at 1 cm above the fluoroscopy table. Image quality was
evaluated using the 19.3 cm CIRS Rad Fluoro phantom, with
the detector positioned 50 cm above the table on both the FPD
and II to compare spatial and contrast resolution at the same 3
magnification levels.
Results: For pulsed fluoroscopy in low-dose mode, exposure
rates (R/min) were lower for the FPD than the II at all mag
levels:At 7.5 fps, mag factors 1, 2, 3, FPD values were: 0.79,
1.18 and 1.62 R/min.II values were: 1.36, 2.32 and 3.90
R/min.In medium-dose mode, measured similarly, FPD
exposure rates were slightly higher than the II at the first mag
level, but lower at the second and third levels: 1.44, 1.78 and
2.10.For continuous fluoroscopy at low-dose, exposure rates
were lower in the FPD at all 3 mag levels: FPD 1.99, 3.11 and
3.8 vs II 2.78, 3.48 and 4.42.At medium-dose, FPD rates were
lower than the II at the first mag level, but higher at the second
and third levels: 2.55, 4.26 and 5.74.Spatial resolution
between low-dose II to low-dose FPD was better on the II (4
objects vs 3 well-delineated). Between low-dose II to medium-
dose FPD, resolution was better on FPD especially for mag 3 (4
objects vs 3 at mag 1; 5 vs 3 at mag 3).Contrast resolution
between low-dose II to low-dose FPD was better on II (3.5-4
objects vs 2.5-3); between low dose II to medium-dose FPD,
contrast was equivalent (3-4 objects for both).
Conclusions: Use of state-of-the-art fluoroscopy FPD
equipment over the traditional II results in radiation dose
savings when operating in low-dose mode, although this comes
at the expense of some image quality. Changing to medium dose
mode eradicates some of the radiation savings and results in
modest gain in image quality which may not be commensurate.
Our findings indicate that care must be taken in initial
equipment calibration, physicist input is important, and image
quality should be tailored to the needs of the specific
examination.
Paper #: 071
Novel Use of Optical Video for Reducing Radiation Dose in
Pediatric Fluoroscopy
Steven Ross, MD, [email protected]; Radiology, El
Paso Children's Hospital, El Paso, TX
Disclosures: Steven Ross, MD: Financial Interest: Personal
Ownership of Provisional Patent - Intellectual Rights: Inventor
and Patent Holder. All other authors have disclosed no financial
interests, arrangements or affiliations in the context of this
activity.
Purpose or Case Report: Fluoroscopic exams are a significant
contributor to pediatric patient radiation dose. Innovations such
as “last image hold”, pulsed fluoroscopy, and digital
fluoroscopy have reduced the patient dose; however,
development of new technology to further reduce dose has been
largely absent in the last decade. A source of dose during
fluoroscopy is “fluoro hunting” which is the use of fluoroscopy
to center the image over the site of interest. The purpose of this
study is to determine if the use of optical video to position the
image before using fluoroscopy can reduce the dose from the
exam.
Methods & Materials: An optical video device was designed
and placed on the fluoroscopy unit used at El Paso Children’s
Hospital. The device was used on 20 consecutive voiding
cystourethrograms (VCUG) and 20 consecutive upper GI (UGI)
exams performed on children ages 2 weeks to 15 years by one
pediatric radiologist. The device was used to center the
fluoroscopy machine in relation to the site of interest prior to
using radiation during these exams. The cumulative air-kerma
area products (KAP) and fluoroscopy times (FT) were recorded
for these exams. This data was compared to the same operator’s
KAP and FT from UGIs and VCUGs performed prior to the
development of this study. A student’s independent sample t-
test was used to compare the KAP and FT from the exams using
the device and those performed without the device.
Results: FT was used as the primary indicator of effectiveness
since KAP also depended on patient sizes. These FTs were
compared to the retrospective control group. The average FT
using the device for UGI was 3 seconds. The average FT from
115 UGIs without the device was 20.7 seconds. This was an
85.5% decrease in FT when using the device. The average FT
using the device for VCUG was 4.5 seconds. The average FT
from 78 VCUGs without the device was 22.8 seconds. This is
an 80.0% decrease in FT when using the device. The student t-
test revealed a statistically significant decrease in FT and KAP
using the device.
Conclusions: This study revealed that using an optical video
device to align patients for fluoroscopic imaging significantly
lowers the FT of both UGI and VCUG. While at least a portion
of the time reduction is likely due to the elimination of “fluoro
hunting”, the reduction was larger than expected. Since the
device allows the use of fluoroscopy to be limited to actual
diagnostic rather than alignment imaging, it also likely increases
the radiologist’s awareness of when radiation is being used.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S100
Paper #: 072
Efficient ALARA Determination using Adaptive Simulated
Low-Dose Pediatric Appendicitis CT and a Psychometric
Function
Steven Don, MD1, [email protected]; Michael F. Lin,
M.D.1, Eric P. Eutsler, M.D.1, David Politte, D.Sc.1, Ruth
Holdener, R.T.R. (M) (CT)1, Craig K. Abbey, Ph.D.2, Bruce
Whiting, Ph.D.3; 1Mallinckrodt Institute of Radiology, St. Louis,
MO, 2University of California, Santa Barbara, Santa Barbara,
CA, 3University of Pittsburgh Medical Center, Pittsburgh, PA
Disclosures: Steven Don, MD:Financial Interest: Vantage
Medical Imaging - Stock: Clinical lead; Fujifilm - Honorarium:
Speaker; Craig Abbey, MD: Consultant, Honoraria: Canon
Medical Research, USA; All other authors have disclosed no
financial interests, arrangements or affiliations in the context of
this activity.
Purpose or Case Report: Evaluate a method to efficiently
characterize the effect of noise on CT readers of pediatric
appendicitis, combining adaptively simulated low-dose images
with a novel parameterized observer response function.
Methods & Materials: CT scans from 201 pediatric patients
(0.27-21.2 years; 115 male-86 female; 84 nonperforated
appendicitis and 117 without appendicitis) acquired on Siemens
Sensation 16, AS 64, or Flash scanners, were used for image
simulation based on 1 mm thick slices. Simulated low-dose
scans formatted in the axial and coronal planes as 3 mm
reconstructions were presented to 3 observers (2 pediatric
radiologists, 1 adult abdominal radiologist). The amount of
added noise was selected based on prior responses of the
individual (adaptive simulation). They marked the location of
the appendix, rated the likelihood for appendicitis on a 6-point
scale (1–definitely normal to 6–definitely appendicitis). The
full-dose study was then presented to the observer, who again
marked the appendix, rated the likelihood for appendicitis and
the visualization of the appendix. The in situ noise in the
appendiceal region was estimated using variance propagation
methods. The intraobserver agreement of readers, matching
between low dose and full dose, was fit to a parameterized
psychometric function (agreement versus noise level) by
maximizing the log-likelihood probability. This function can be
used to analytically compute a noise shoulder Ν∑, which
characterizes a reader’s sensitivity to noise. Readers’ responses
for appendicitis and normal cases were also separately analyzed.
Results: At full dose the observers had an area under the curve
(AUC) of 0.973(0.018, stdev) and selected locations had a mean
noise of 9.9 (4.3) HU. Individual readers had a range of noise
tolerances (shoulder location), with mean tolerated noise of 23.6
HU (range 18.9-30.3). This equates to an 85% dose reduction.
In general, appendicitis cases were less tolerant of noise
reduction than normal cases.
Conclusions: The adaptive psychometric function is a
promising tool to efficiently determine ALARA for task-
specific CT diagnosis, providing an order of magnitude
reduction in cases needed compared with receiver operating
characteristic curves. These results indicate that estimated CT
dose decreases of 85% or a noise ceiling of 23.6 HU could be
tolerated without affecting agreement.
Paper #: 073
Radiation burden associated with imaging of suspected
appendicitis-related abscess: Pathway to a radiation free
MR appendicitis imaging protocol
Joshua H. Finkle, MD, [email protected]; Cynthia K.
Rigsby, MD, Timothy Lautz, MD, Nicole Murphy, Christina L.
Sammet, PhD, DABR; Radiology, Ann & Robert H. Lurie
Children's Hospital of Chicago, Chicago, IL
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Abscess formation is a common
appendicitis complication both pre- and post-operatively. At our
institution, MR is exclusively used to evaluate for acute
appendicitis after an equivocal or non-diagnostic US study, and
contrast-enhanced CT is the test of choice only when abscess is
suspected clinically or following US. Our aims are to 1) assess
the radiation burden of patients who undergo CT for suspected
appendicitis-related abscess and 2) determine the frequency of
abscess detection and positive predictive value (PPV) for
abscess detection of non-contrast appendicitis MR including
diffusion weighted imaging in the setting of suspected
appendicitis.
Methods & Materials: We performed an IRB approved
retrospective review of all children who between 2015 and 2018
underwent CT after an US study suspicious for abscess in the
setting of either suspected appendicitis or to evaluate for abscess
post-appendectomy. CT effective dose was calculated using
Monte Carlo simulation software (Radimetrics, Bayer
Healthcare). We also reviewed all MR studies performed after
an equivocal US for acute appendicitis to determine the
frequency of abscess detection and the positive predictive value
(PPV) of MR for abscess evaluation. Clinical course including
surgery or interventional (IR) drainage was recorded for patients
with abscesses by CT or MR.
Results: 220 CT studies in 165 patients (mean 9.3+/-3.8 years,
58% male) were performed for abscess evaluation with a mean
CT effective dose of 9.8 mSv per exam or 13.1 mSv per patient.
35% of patients (57/165) had CT imaging related to initial
appendicitis presentation of which 70% (40/57) were positive
for abscess; 48% (19/40) went on to IR drainage, 45% (18/40)
to surgery. 65% of patients (108/165) had CT imaging post-
appendectomy of which 66% (71/108) were positive for
abscess; 76% (54/71) went on to IR drainage and 7% (5/70) to
surgery. The patients who did not have IR drainage or surgery
were treated conservatively with antibiotics. Of 893 MR exams
for appendicitis, 20 were read as positive for abscess and all had
proven abscess by operative or IR drainage, PPV of 100%.
Additional ongoing MR data collection will be presented in
detail.
Conclusions: There is a substantial CT radiation burden with an
average of 13 mSv per patient to evaluate for abscess in the
setting of appendicitis. MR has a high PPV for abscess detection
suggesting it is a viable alternative to CT and allows for a
radiation-free appendicitis imaging pathway.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S101
Paper #: 074
Implementation of Single-Source Dual-Layer Spectral CT in
a Pediatric Imaging Department: Addressing Dose
Neutrality and Maintenance of Image Quality in
Abdominal-Pelvic CT in Children
Richard Southard, MD, [email protected];
Nicholas Rubert, PhD, Robyn Augustyn, BSRT RT(R)(CT),
M'hamed Temkit, PhD, Mittun Patel, MD, Dianna M. Bardo,
MD; Department of Medical Imaging, Phoenix Children's
Hospital, Phoenix, AZ
Disclosures: Dianna M. Bardo, MD: Consultant, Honoraria;
Speakers Bureau: Koninklijke Philips, NV. All other authors
have disclosed no financial interests, arrangements or
affiliations in the context of this activity.
Purpose or Case Report: To assess the effect of single-source
dual-layer (SSDL) CT on radiation exposure and image quality
in pediatric patients undergoing contrast-enhanced abdominal-
pelvic CT examinations.
Methods & Materials: We reviewed 395 consecutive
abdominal-pelvic CT examinations between December 2017
and April 2018: 152 patients (123 months, 2-268 months)
imaged on SSDL using 120 kVp compared with 243 patients
(119 months, 0.8-270 months) imaged on single-energy CT
(SECT) using weight-based protocols (80 kVp/100kVp/120
kVp), matching automatic exposure control, hybrid-iterative
reconstruction and image quality indices. Image quality (IQ)
metrics included SNR, CNR and subjective radiologist scores.
Dose calculations included CTDIvol and size-specific dose
estimates (SSDE).
Results: Comparing all SSDL and SECT patients, there was
CTDIvol dose parity (4.0 mGy vs. 3.6 mGy, p=0.0840), with
individual weight subgroup dose increase of 5%-11% for
CTDIvol and 2-12% for SSDE. SNR, CNR and IQ scores were
maintained or improved in all SSDL weight groups with the
exception of 15% reduced CNR in the 0-30 kg subgroup. We
present representative cases which demonstrate how CNR can
be recovered with low-energy virtual mono-energetic (mono-E)
images (VMI) following material decomposition of the spectral
data. Our measured SSDL doses were comparable or lower than
those reported for children imaged using other dual-energy
scanners and compared to the ACR national dose index registry
for pediatric body CT, would rank in the lower quartiles of
reported CTDIvol. Minor dose increase observed in patients
despite matching AEC and dose index are likely secondary to
machine differences in filters, collimation and a softer beam
spectrum.
Conclusions: SSDL can be safely implemented in a pediatric
department with overall dose neutrality and maintained image
quality; however, there may be increased dose observed in the
smallest patients despite matching AEC and dose index likely
secondary to differences in filters, collimation and softer beam
spectrum. Spectral CT offers many benefits by virtue of
material-specific information in addition to diagnostic anatomic
detail, and VMI low mono-E reconstruction can recover CNR
potentially lost with use of higher kVp. To our knowledge, we
are the first to explore dose-neutrality in children undergoing
abdominal-pelvic CT examinations using single-source dual-
layer spectral CT.
Paper #: 075
Size-specific dose estimate reference levels for pediatric
abdominopelvic examinations using single and dual-energy
dual-source CT
Marilyn J. Siegel, MD1, [email protected]; Juan Carlos
Ramirez Giraldo, PhD2; 1Mallinckrodt Institute of Radiology,
Washington University St Louis, St Louis, MO, 2Computed
Tomography R&D, Siemens Healthineers, Malvern, PA
Disclosures: Marilyn J. Siegel, MD: Financial Interest: JCRG
is an employee of Siemens Healthineers - Salary: JCRG is a
senior key expert scientist working for Siemens; Juan Carlos
Ramirez Giraldo, PhD: JCRG is scientist employed by
Siemens. All other authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To present size-specific dose
estimate (SSDE) reference levels for pediatric abdominopelvic
single-energy CT (SECT) and dual-energy CT (DECT)
examinations
Methods & Materials: This single-center HIPPA-compliant
study was approved by institutional review board. Retrospective
CT dose data were collected in pediatric patients (mean age
9.3±5.9 years) from September 2014 until March 2018) using
dose tracking software. Contrast-enhanced abdominopelvic CT
studies were sorted into two categories: single energy CT
(SECT) (N=1719) and DECT (N=375) CT. Clinical indications
included abdominal pain, mass, bowel diseases. Size-specific
dose estimates (SSDEs) based on body circumference and
volume CT dose index (CTDIvol) were calculated. All
examinations were performed on a dual-source CT system
(Somatom Flash, Siemens Healthineers). Both SECT and DECT
acquisitions used automatic exposure control and iterative
reconstruction. SECT was performed using kilovoltages ranging
from 70 to 120 kVp. Patient data were grouped into one of five
body circumferences. The median, 25th and 75th quartile of the
SSDEs within each circumference group was calculated.
Statistical unpaired comparisons were made between groups.
Subjective image quality (scale 1, excellent, to 4, non-
diagnostic) of 25 DECT and SECT scans from each
circumference group was assessed.
Results: For the five effective diameters (< 15cm, 15-19cm, 20-
24cm, 25-30 cm and > 30cm), the median SSDE [25th-
75th quartile] for DECT and SECT were 6.3[5.9-6.7] mGy and
7.8 [6.5-8.2] mGy (P > .05); 6.7[6.3-7.4] mGy and 7.5 [6.6-7.8]
mGy (P > .05); 7.8[7.3-8.7]mGy and 7.9 [6.7-9.7] mGy (P >
.05); 8.9[8.2-9.6] and 9.9[8.7-10.7] mGy (P < .01) ; 10.8[9.9-
12.6] and 12.2[11.0-14.3] (P < .05), respectively. The SSDE for
DECT was statistically lower than that of SECT in patients with
circumferences > 25 cm (P < .01). SSDE for DECT and SECT
were not significantly different in smaller patients. Image
quality was also similar for both DECT and SECT.
Conclusions: The SSDE diagnostic references levels in this
study as a function of body circumference can provide guidance
to establish reference radiation exposures in clinical practice for
contrast-enhanced DECT and SECT in pediatric
abdominopelvic CT on a dual-source CT scanner. The SSDEs
of DECT are comparable or lower than those of SECT.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S102
Paper #: 076
Plain film findings in ileocolic intussusception. Why should
we care?.
Dhruv Patel, MD, Jonathan M. Loewen, MD, Kiery
Braithwaite, MD, Sarah Milla, MD, Edward Richer, MD,
[email protected]; Radiology, Emory University, Atlanta,
GA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Determine the spectrum of plain film
findings encountered in ileocolic intussusceptions and assess
their predictive value in reducibility by therapeutic enema, and
in surgical outcomes in patients with failed reductions.
Methods & Materials: An IRB approved, retrospective study
was performed. The radiology information system at our
institution was queried for the keyword “intussusception” in
fluoroscopic reports from September 2012 – August 2017. Two
authors then reviewed plain films obtained prior to therapeutic
enema, when available, for the following findings: normal,
paucity of bowel gas, soft tissue mass, meniscus sign, or
obstruction. When plain films were not available, the scout
image from the therapeutic enema was reviewed. Disagreements
were resolved by consensus. The medical record was then
reviewed for each patient to determine success of therapeutic
enema, and surgical outcome in cases of failed reduction.
Complicated surgical cases were defined as those that required
more extensive surgery than a standard laparoscopic reduction,
such as conversion to open laparotomy.
Results: 182 total cases of intussusception reduction were
identified and reviewed. A normal bowel gas pattern was seen
in 14%, paucity of bowel gas in 65%, soft tissue mass in 26%,
meniscus sign in 12%, and obstruction in 10%. Percentages total
> 100% due to more than one finding in some patients. A
normal bowel gas pattern was associated with the highest
therapeutic enema success rate (83%) and lowest rates of
complicated surgery (4%) and bowel resection (4%).
Conversely, bowel obstruction was associated with the lowest
enema success rate (21%), and highest rates of complicated
surgery (47%) and bowel resection (42%). Patients with bowel
obstruction had a significantly higher likelihood of needing
surgical reduction (OR 9.0, 95% CI 2.84-28.47) and bowel
resection (OR 11.1, 95% CI 3.66-33.86) than those without
obstruction. Paucity of bowel gas, presence of soft tissue mass,
and meniscus sign showed enema success rates and surgical
outcomes intermediate between normal and obstruction.
Conclusions: In most cases of ileocolic intussusception, plain
films show an abnormality, with paucity of bowel gas being the
most common finding. Plain film findings can provide
important prognostic information to both the radiologist and the
surgeon, with significantly lower enema reduction rates and
higher rates of complicated surgeries in patients with bowel
obstruction.
Paper #: 077
Recurrent Intussusceptions in Children
Grace M. Ma, MD1, [email protected]; Craig Lillehei,
MD2, Michael J. Callahan, MD2; 1Radiology, The Hospital for
Sick Children, Toronto, Ontario, Canada, 2Boston Children's
Hospital, Boston, MA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Air-contrast enema (ACE) is an
effective treatment for ileocolic intussusception (ICI). There is
currently no consensus on the number of ACE attempts for
multiple ICI prior to surgery. The purpose of this study is to
review the patterns of ICI and ACE success rates in patients
with and without recurrence and to determine the number of
ACE attempts to be considered for recurrent ICI that may
obviate the need for surgery.
Methods & Materials: Retrospective review of 683 children (≤
18 years) with ACE for ICI between January 2000-May 2018.
Recurrent ICI were separated into mutually exclusive
categories: short-term (ST, ≤7 days between episodes) and long-
term (LT, > 7 days between episodes) ICI. ACE success rates
and rates of pathologic lead point (PLP) were calculated.
Results: 606/683 (89%) patients had at least 1 successful ACE
ICI reduction. 115/606 (19%) patients had ≥1 recurrent ICI. The
success rate after the initial successful ACE for those with
recurrent ICI was 96% (110/115), with only 5 patients
undergoing surgery for failed ACE on the recurrent ICI. 9/115
(7.8%) patients underwent subsequent surgery despite
successful ACE for multiple recurrences (n=7), and PLP seen
on ultrasound (n=2). Overall, 101/115 (88%) patients with
recurrent ICI underwent successful ACE without subsequent
surgery. PLP was identified in 3.5% and 4.3% of patients with 1
ICI and >1 ICI, respectively. Of those with >1 ICI (recurrence),
PLP was identified in 11% (2/19) of patients with only LT ICI,
and none of the 77 patients with only ST ICI. In those with ≤4
ST only ICI, 96% (67/70) of patients underwent successful ACE
without surgery. Of the 3 patients who underwent subsequent
surgery, 2 were related to failed ACE during the first recurrence
and 1 was related to recurrence after successful reduction on
ACE.
Conclusions: The majority of recurrent ICI are successfully
treated by repeat ACE. Patients with LT ICI are more likely to
need surgery due to higher PLP rates. Nevertheless, most
patients with ≤4 ST ICI underwent successful ACE without
surgery. In the correct clinical context, we propose that ACE
could be attempted at least 4 times in patients with ST recurrent
ICI.
Paper #: 078
Piriform Fossa Sinus Tract - A 15 year retrospective review
of cases from birth to adolescence presenting to a Children's
Hospital
Makabongwe Tshuma, MBChB (Hons); FRCR,
[email protected]; Heather Bray, MD, Anna Lee, MD,
Neil Chadha, MD, Jim Potts, MD; BC Children's Hospital /
University of British Columbia, Vancouver, British Columbia,
Canada
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: An underlying Piriform Fossa Sinus
Tract (PFST) may be overlooked in children presenting with
cystic neck mass or suppurative thyroiditis, leading to recurrent
infection possibly life threatening. We aim to determine the
pattern of presentation, imaging findings and management of
PFST in children and define the most appropriate imaging
investigations.
Methods & Materials: A retrospective analysis of the clinical
presentation, imaging findings and management of 16 cases of
PFST presenting to our tertiary children’s hospital between
2003 and 2018. Cases were identified by medical records and
PACS search using relevant ICD-10 coding. Statistical analyses
with SAS Statistical Software® version 9.4
Results: Age at presentation ranged from prenatal to 16 years
with a male to female ratio of 2:1. All patients presented with
neck swelling, 13(81%) had neck infection/suppurative
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S103
thyroiditis at initial presentation. Two patients had severe
thyroiditis/mediastinitis requiring ICU admission. Three
neonates presented with non-infected cystic neck masses; two
had been detected prenatally. Two neonates were presumed to
have lymphatic malformations, with spontaneous clinical
resolution by three months of age later re-presenting with
evidence of PFST. PFST was left-sided in 94%. Eight patients
were initially diagnosed with branchial cleft cyst and underwent
cyst resection ± hemithyroidectomy without consideration for
PFST. These patients re-presented with multiple episodes of
recurrent neck abscess. All patients had neck imaging prior to
definitive diagnosis. Imaging studies included radiographs,
ultrasound, CT, MRI and Upper GI contrast studies. No single
modality was diagnostic of PFST in all patients with 75%
undergoing multimodality imaging prior to diagnosis. PFST was
identified on upper GI study in 6/12 patients. All cases were
confirmed by endoscopic visualization. The interval from
presentation to endoscopy was 2.6-174 months.Management of
PFST was via endoscopic cauterization in 13 patients, surgery
in 2, and 1 patient did not require either.
Conclusions: This study highlights the complex nature of
PFST. This anomaly is uncommon, has variable clinical and
imaging presentations and may have a lengthy, complicated
course if not considered at initial presentation. An episode of
suppurative thyroiditis in a child should prompt investigation
for a PFST. We are the first group to describe the atypical
presentation of a neonatal cystic neck mass undergoing
spontaneous clinical resolution but re-presenting as a PFST.
Paper #: 079
Ultrafast PET/CT: A qualitative and quantitative analysis of
reduced imaging times using Digital PET/CT
Andrew Sher, MD, [email protected]; Raymond B.
Pahlka, PhD., Wei Zhang, Victor J. Seghers, M.D.; Pediatric
Radiology, Texas Children's Hospital, Houston, TX
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Analyze the feasibility of a
performing an ultrafast Digital PET/CT on pediatric patients by
comparing image quality and SUV quantification of normal
structures using multiple simulated time-per-bed position
protocols.
Methods & Materials: This HIPAA compliant retrospective
study had IRB approval. 10 patients ranging in age from 3 to 17
years old had an 18F-FDG PET/CT performed on a digital
PET/CT scanner at a tertiary academic hospital. In addition to
the clinical standard 120-seconds per bed position scan,
simulated PET images were generated using list mode data to
create PET data sets at 30-, 60-, and 90-seconds per bed
position. Two readers blinded to time-per-bed position assessed
the data evaluating image quality using a 5-point Likert scale (1:
extremely poor quality study with major artifacts that is not
clinically useful, 2: poor quality study with major artifacts,
whose clinical use is not advised, 3: average study with
moderate artifacts, probably affecting clinical use, 4: good study
with only minor artifacts not affecting clinical use, 5: excellent
study without artifacts). SUVmax was calculated on seven
regions of interest placed on physiologic structures for each data
set. Spearman correlation and relative median and interquartile
ranges were calculated.
Results: 40 reconstructed data sets from 10 patients were
analyzed. Mean Likert scores for the 30-second, 60-second, 90-
second and 120-second images were 3.7, 4.3, 4.6 and 4.7 for
Reader 1 and 4.1, 4.9, 4.8, and 4.9 for Reader 2, respectively.
Reader 1 found three 30-seconds per bed position scans below
clinical acceptance, Reader 2 found all images clinically
acceptable. For the 70 regions of interest per data set, there was
near perfect SUVmax correlation with the standard 120-seconds
per bed position exam (ρ = .98, .994 and .997 respectively for
30, 60 and 90 seconds per bed position, p<.00001). The median
and interquartile ranges of the relative SUVmax differences for
the 30-, 60- and 90-seconds per bed position exams compared to
the clinical standard were 15% (7-27%), 6% (1-14%) and 3% (-
1- 7%) respectively.
Conclusions: Our study demonstrates the feasibility of
performing ultrafast PET/CT in pediatric patients on a digital
PET/CT. Reduction in scan times of up to 50% (60 seconds) are
attainable without adversely affecting the SUVMax
measurements or image interpretability. Digital PET/CT using
an ultrafast protocol is a promising technology that may result
in decreased imaging times and improved patient compliance.
Paper #: 080
Utility of 18F-FDG PET/CT following ketogenic diet in
detecting endocarditis in children and adult congenital heart
disease patients.
Jason Gillum, MD, [email protected]; Neha
Kwatra, MD, Laura Drubach, MD, Douglas Y. Mah, MD,
Stephan Voss; Radiology, Boston Children's Hospital, Boston,
MA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Congenital heart disease patients are
at increased risk of infective endocarditis, related to implantable
devices such as prosthetic valves and pacemarkers. With
standard PET/CT protocols, physiologic myocardial glucose
uptake limits the assessment of the heart and related cardiac
structures. The objective of the present study is to evaluate the
utility of 18F FDG PET/CT following ketogenic diet preparation
in children and adult congenital heart disease patients in
confirming suspected endocarditis.
Methods & Materials: Congenital heart disease patients who
had undergone FDG PET/CT for suspected endocarditis were
identified using a database search. A total of 25 individual
patients were identified. Of these, 22 had undergone PET/CT
specifically for evaluation of suspected endocarditis. Patients
who underwent PET/CT for non-endocarditis indications were
excluded from the remainder of the analysis. At the time of their
index PET/CT scans, the ages of the 22 evaluated patients
ranged from 11 months to 65 years of age, with a median age of
24 years. PET/CT findings were correlated with peripheral
blood cultures, surgical findings, explant cultures and
histopathology, and clinical course.
Results: Ketogenic dietary preparation was successful
(myocardial uptake visually suppressed) in 16 of 22 patients.
The majority of the patients (18/22) had focal FDG PET/CT
findings suspicious for endocarditis, while 4 had negative or
nonspecific scans. 14 of 22 patients subsequently were managed
surgically; 13 of these patients had explant specimens with
histologic evidence of infection and/or positive cultures. The
remainder of the patients received antibiotic therapy; five of
these clinically managed patients were followed to symptom
and/or imaging resolution. Clinically significant non-cardiac
PET findings were identified in six patients (e.g. osteomyelitis)
that potentially changed management.
Conclusions: Given an adequate index of clinical
suspicion, 18F-FDG PET/CT is a sensitive and specific imaging
modality for diagnosing infective endocarditis in the congenital
heart disease population, particularly in patients with prosthetic
valves or other device implants in whom other imaging
modalities such as echocardiography are limited by hardware-
associated acoustic artifacts. In certain patients in whom
endocarditis is not diagnosed other sites of remote spread of
infection may also be identified.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S104
Paper #: 081
Standardized Uptake Values on PET/MR scans are not
affected by iron oxide nanoparticles
Anne M. Muehe, MD, [email protected]; Ashok J.
Theruvath, MD, Jayne M. Seekins, MD, Heike E. Daldrup-Link,
MD, PhD; Radiology, Stanford University, Palo Alto, CA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Treatment response assessment of
pediatric cancer patients relies on accurate measurement of
standardized uptake values (SUV) of tumors and normal organs
on positron emission tomography (PET). Ferumoxytol is an iron
oxide nanoparticle compound that can be used “off label” as a
contrast agent for integrated PET/MR scans. However,
ferumoxytol tissue enhancement could affect MR-based
attenuation correction (AC) of PET data. The purpose of our
study was to evaluate if SUV values generated from either
ferumoxytol-enhanced and unenhanced MRAC maps were
significantly different.
Methods & Materials: 30 children (6-18 years) with malignant
tumors underwent 18F-FDG PET/MR scans (dose 3 MBq/kg)
with (n=15) or age- and sex-matched to patients without (n=15)
intravenous injection of ferumoxytol (5 mg Fe/kg). MRAC was
obtained by a two-point Dixon LAVA sequence accounting for
fat, air/background, lung, and soft tissue. We compared the
signal to noise ratio (SNR), SUVmean and SUVmax, calculated
based on body weight (bw) and body surface area (bsa) of
blood, brain and normal organs on enhanced and unenhanced
MRAC and PET images using a mixed effects linear model. In
addition, we compared the number of tissue misclassifications
on ferumoxytol-enhanced and unenhanced AC-maps by Poisson
regression model. All comparisons were performed assuming
alpha of 0.05.
Results: The SNR of the blood, brain, and visceral organs on
ferumoxytol-enhanced scans was significantly higher compared
to unenhanced scans (p<0.001). The SUVmean and SUVmax
values of different organs based on bw or bsa on ferumoxytol-
enhanced and unenhanced AC-maps were not significantly
different (all p>0.05). Ferumoxytol-enhanced AC-maps showed
no significant difference in tissue misclassifications (p=0.09).
Conclusions: Ferumoxytol administration does not affect SUV
measurements on 18F-FDG PET/MR scans. Therefore,
unenhanced scans can be omitted, and the acquisition of
PET/MR scans can be accelerated by obtaining all images after
primary contrast agent injection.
Paper #: 082
Radiomic analysis of staging CT scans for neuroblastoma:
An initial investigation of correlations with tumor histology,
MYCN status, INRG stage, relapse and death
Matthew A. Zapala, MD, PhD, [email protected];
William Temple, MD, Mimi Poon, MD, Kieuhoa Vo, MD,
Katherine Matthay, MD, Andrew Phelps, MD, Spencer Behr,
MD/PhD, Benjamin Franc, MD, Youngho Seo, PhD;
Radiology, UCSF Benioff Children's Hospital, San Francisco,
CA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To correlate computer-generated
radiomic features from staging CT scans of neuroblastoma with
clinical and histopathological features.
Methods & Materials: A retrospective cohort study of patients
enrolled on the Children’s Oncology Group study ANBL00B1
at a tertiary care academic pediatric hospital from 2000-2015
with pathology-proven neuroblastoma. Clinical data collected
included relapse and death, MYCN copy number,
histopathology, and International Neuroblastoma Risk Group
(INRG) stage. A total of 35 pediatric patients (age range 0-14.6
years, mean age 2.9 years, 17 males and 18 females) met
inclusion criteria. Primary tumor foci were hand-segmented
from initial staging CT scans using the freely available open
source 3D-slicer (https://www.slicer.org). A CAQ-qualified
pediatric radiologist with 8 years experience independently
reviewed the hand-segmented primary tumors for accuracy.
Radiomic feature extraction was performed using the
Pyradiomics library, an extension of 3D-slicer, with a total of
105 quantitative features. Spearman rank correlations were
performed between radiomic features and clinical and
histopathological features (sorted rho > 0.4 and p-value < 0.05).
Results: Shape features, as opposed to first and second order
quantitative statistical features, were the most correlated with
histology (8 of the top 10), MYCN status (7 of the top 10),
INRG stage (6 of the top 10), and death (8 of the top 10). Only
relapse had a minority of shape features in the top 10 (3 of 10),
however no other radiomic feature had more than 2 in the top 10
for relapse. Most statistically significant radiomic features
demonstrated moderate agreement at best (rho = 0.4-0.59, p-
value < 0.05). The highest correlation was strong agreement
between 2D diameter and INRG stage (rho = 0.65 p-value = <
0.0001).
Conclusions: While this initial study has a small sample size of
35 patients, it is the first study to look at the radiomic features
of neuroblastoma and attempt to identify relationships with
histopathology and clinical outcomes. Interestingly, the majority
of radiomic features that demonstrated at least a moderate
statistically significant correlation with histopathology and
clinical outcome were shape features that can be visually
identified by radiologists.
Paper #: 083
Monitoring Response to Immunotherapies in
Neuroblastoma Using Nanoparticle Contrast-Enhanced CT
Laxman Devkota, PhD1, [email protected];
Charlotte H. Rivas1, Andrew A. Badachhape, Ph.D.1, Igor
Stupin2, Mayank Srivastava2, Zbigniew A. Starosolski, PhD2,
Ananth Annapragada2, Robin Parihar, MD, PhD1, Ketan B.
Ghaghada, PhD2; 1Pediatric Radiology, Baylor College of
Medicine, Houston, TX, 2Texas Children's Hospital, Houston,
TX
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: The tumor microenvironment (TME)
in neuroblastoma (NB) is a key regulator of treatment resistance
and disease relapse. Myeloid-derived suppressor cells (MDSCs)
play a central role in maintaining the TME in NB by
suppressing host immunity, driving angiogenesis, and
remodeling tissue. Since MDSCs play a central role in
angiogenesis, we hypothesized that MDSC-targeted therapies
will alter the architecture of tumor vasculature. In this pre-
clinical study, we investigated contrast-enhanced CT (CECT)
using a long circulating liposomal-iodine (Lip-I) nanoparticle
contrast agent for monitoring changes in tumor vasculature in
response to MDSC-targeted immunotherapy.
Methods & Materials: In vivo studies were performed in three
groups of humanized mice: 1) NB tumor cells (Tumor group);
2) NB tumor cells + human MDSCs (Tumor+MDSC group) and
3) NB tumor cells + MDSC cells + Immunotherapy (MDSC-
directed Therapy group). For the Therapy group, MDSC-
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S105
directed natural killer (NK) cells were intravenously
administered 10 days prior to CT imaging. CECT was
performed at 2 and 4 weeks post-tumor implantation. Lip-I was
injected four days prior to CT. On the day of imaging, non-
contrast CT was performed to determine tumor vascular
permeability. A second dose of Lip-I agent was administered
and CT angiogram acquired to determine tumor vascularity.
Tumors were segmented to study 3D spatial variations in
vascular structure. Animals were then euthanized to determine
MDSC burden and peri-vascular localization using flow
cytometry and immunohistochemistry (IHC).
Results: Quantification of CT signal demonstrated a 2.2-fold
increase in vascularity for Tumor+MDSC group compared to
Tumor group. Further, IHC analysis revealed a higher vascular
density and a predominant perivascular distribution of MDSCs
in Tumor+MDSC group, indicating a role for MDSCs in tumor
angiogenesis. The MDSC-directed Therapy group showed a 4-
fold reduction in tumor vascularity compared to Tumor+MDSC
group, suggesting a reduction in MDSC burden. Flow cytometry
analysis corroborated with CECT findings and demonstrated a
6-fold reduction of MDSC burden in MDSC-directed Therapy
group compared to Tumor+MDSC group.
Conclusions: Contrast-enhanced CT using a nanoparticle
contrast agent enabled assessment of changes in tumor
vasculature in response to MDSC burden. The imaging
methodology could facilitate monitoring acute response to
MDSC-targeted therapies in neuroblastoma and other solid
tumors.
Paper #: 084
Gadolinium-based contrast media improve detection of
image defined risk factors at diagnosis of neuroblastoma
Reem Hasweh, [email protected]; Christopher G. Anton,
MD, Andrew T. Trout, Ethan A. Smith, MD, Jonathan R.
Dillman, MD. MSc, Emily Orscheln, MD, Bin Zhang,
Alexander J. Towbin, MD; Department of Radiology,
Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
Disclosures: Andrew T. Trout, MD: Consultant, Honoraria:
Guerbet Group, Royalty: Elsevier, Wolters-Kluwer, Research
Grants: Canon Medical, Siemens Medical Solutions, National
Pancreas Foundation, In-Kind Support: ChiRhoClin Inc.,
Perspectum Diagnostics; Jonathan R. Dillman, MD. MSc:
Research Grants: Canon Medical Systems; Siemens
Healthineers; Perspectum Diagnostics; Bracco Diagnostics,
Other: Travel Support (Philips Healthcare, GE Healthcare). All
other authors have disclosed no financial interests, arrangements
or affiliations in the context of this activity.
Purpose or Case Report: MRI with gadolinium-based contrast
material (GBCM) is one of the modalities used to diagnose and
characterize neuroblastoma. However, the use of GBCM is not
without risk. Recent data have shown variable retention of
GBCM in the brain, bones, and other organs. In addition,
GBCM adds cost and time to the imaging study. The purpose of
our study was to determine if GBCM are needed to identify
image-defined risk factors (IDRF) in patients with
neuroblastoma.
Methods & Materials: A retrospective case-control study was
performed. All patients who received an abdominal MRI at the
time of diagnosis of intra-abdominal neuroblastoma were
included. Each exam was duplicated with the contrast-enhanced
images removed from one copy of the exam. A single pediatric
radiologist blinded to study purpose reviewed the separated
imaging exams in a random order on our research PACS
measuring three dimensions of the tumor (width x length x
height), reporting the presence or absence of each potential
abdominal IDRF and the presence or absence of metastatic
disease. Considering the exam including contrast-enhanced
images as the reference-standard, Kappa coefficient, sensitivity
and specificity were calculated for the detection of IDRF and
metastases. A paired t-test was used to compare differences in
tumor measurements.
Results: 50 patients were included in the study. There was no
significant difference between groups for any diameter
measurement (p-values: 0.82-0.9). However, there was a
statistically significant difference in the detection of each IDRF
as well as for the detection of metastatic disease. The kappa
value ranged from 0.46 to 0.94 for IDRF detection (p-value
range 0.007 to <0.001) and from 0.23 to 1 for the detection of
metastatic disease (p-value range 0.01 to <0.001). The
sensitivity of IDRF detection ranged from 0.81 to 1 while
specificity ranged from 0.33-1. The highest sensitivity of the
non-contrast images was for detection of lower mediastinal
invasion, superior mesenteric artery encasement, and lung
metastasis while the highest specificity was for infiltration of
the porta hepatis, encasement of the iliac vessels, invasion to the
liver, and detection of lung metastases.
Conclusions: GBCM does not significantly improve a
radiologist’s ability to measure neuroblastoma size. However,
use of GBCM is associated with a significant difference in the
detection of IDRFs at diagnosis.
Paper #: 085
The Structured Report for Oncology – An Important Tool
for Oncologists and Radiologists
Daphine Grassi, MD, [email protected]; Summer
Kaplan, MD MS, Janet R. Reid, MD, FRCPC, Lisa States;
CHOP, Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Determine radiologists’ and
oncologists’ perceived impact of the structured report on
clinical workflow, point of care teaching, and research in a large
academic pediatric institution.
Methods & Materials: Fellows and attending radiologists from
both radiology and oncology departments at our institution
completed an online survey regarding their perceptions of the
impact of the structured report on workflow, teaching and
research. Surveys were sent to 42 radiologists and 51
oncologists.Two different surveys were created with specific
directed questions for radiology and oncology; there were 7
questions in the oncology survey and 10 in the radiology survey.
The structured report template was included with the survey to
serve as a convenient reference.
Results: The survey was completed by 50% of the radiologists
and 27% of the oncologists. All oncologists claimed their
preference of structured over free text reports. 70% of
oncologists reported fewer questions for the radiologists after
implementation of structured reporting. 64.3 % reported
improved workflow efficiency and improved clinical
management of their patients. 75% of radiologists preferred
structured reporting, with 70% claiming improved accuracy of
their reports and a more efficient process when asked to review
cases with the referring clinicians. Of interest, 80% of
radiologists considered using structured reports as a teaching
tool while 50% of the oncologists used them for this purpose
Conclusions: Our results show that radiologists and oncologists
perceive a significantly positive impact of the structured report
for pediatric tumors on workflow and efficiency of initiating
care. In addition the structured report provides a teaching tool to
enhance the current educational experience for trainees in both
radiology and oncology programs.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S106
Paper #: 086
Are Ferumoxytol-enhanced MRI scans equally suitable to
evaluate tumor size and extension of pediatric bone tumors
compared to Gadolinium-enhanced MRI scans?
Florian Siedek, MD, [email protected]; Anne M. Muehe,
MD, Ashok J. Theruvath, MD, Raffi S. Avedian, MD, Sheri
Spunt, Jarrett Rosenberg, Crystal R. Farrell, MD, Heike E.
Daldrup-Link, MD, PhD; Department of Radiology, Stanford
University School of Medicine, Stanford, CA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To investigate if Ferumoxytol (Fe)-
enhancement in MRI scans influences assessment of tumor size
and extension in pediatric bone tumors compared to Gadolinium
(Gd)-enhancement in a clinically relevant manner. We
hypothesized that tumor size and extension can be equally
assessed on Fe-MRI scans and Gd-MRI scans.
Methods & Materials: In this retrospective, IRB-approved
study, we compared quantitative and qualitative image
parameter of bone tumors in 13 patients (11 osteosarcomas, 2
Ewing sarcomas; 9m/4f; 15.9 ± 4.7y/o) that received a Fe- and a
Gd-MRI scan within one month of each other and before
treatment initiation. One investigator measured the maximum
tumor length in 3 orientations and the tumor volume on T1w-
LAVA, T1w-SE and T2w-FSE sequences. Results were
compared using Bland Altman analysis. In addition, 3
radiologists independently evaluated tumor involvement of the
diaphysis, metaphysis and epiphysis using a Likert-scale.
Results were pooled across readers and then analyzed according
their agreement on tumor assessment (affected –
yes/no/uncertain) and confidence
(uncertain/probably/definitely).
Results: Tumor lengths were not significantly different on Fe-
MRI and Gd-MRI scans with mean differences of 0.13±0.72cm
(axial-short axis), 0.28±0.59cm (axial-long axis) and
0.29±0.79cm (coronal) with 95% limits of agreement
(95%LoA) of -1.27–1.53cm, -0.88–1.43cm and -1.84–1.26cm
respectively and high concordance correlation coefficients
(CCC) of 0.97 (axial-la) and 0.98 (axial-sa/cor). The tumor
volume also showed a strong similarity with a mean difference
of 5.86±43.81 mm2 with 95%LoA of -80.0 – 91.7 mm2 and an
even higher CCC of 0.99. The assessment of tumor presence in
the metaphysis and the associated confidence showed perfect
agreement for all sequences (1.0, 1.0) of the Fe- and Gd-scans.
For the diaphysis, the assessment and confidence, respectively,
showed highest agreement for T1-LAVA (0.99, 0.98) and lower
agreement for both T2-FSE (0.87, 0.85) and T1-SE (0.87, 0.85).
For the epiphysis, the assessment and confidence showed the
highest agreement for T2-FSE (0.94, 0.90), slightly lower for
T1-LAVA (0.91, 0.85) and the lowest for T1-SE (0.77, 0.73).
Conclusions: Our results suggest that Fe-enhanced MRI scans
can be equally used for assessment of tumor size and extension
in pediatric bone tumors compared to Gd-enhanced MRI scans.
Paper #: 087
Diagnostic Accuracy of Imaging Approaches for Early
Tumor Detection in Patients with Li-Fraumeni Syndrome
Thitiporn Junhasavasdikul, MD, Sanuj Panwar, Armin
Abadeh, Anita Villani, MD, David Malkin, Andrea Doria,
MD, [email protected]; The Hospital for Sick Children,
Toronto, Ontario, Canada
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To assess the accuracy of imaging
techniques currently used in practice for early detection of
tumors in patients with Li-Fraumeni syndrome (LFS).
Methods & Materials: Two radiologists retrospectively
reviewed all available imaging data from patients with LFS
(January 1999 to September 2017). Based on the results from
the imaging analysis, lesions were categorized into benign,
malignant and indetermined. Histopathological and clinical
information were also obtained and independently reviewed.
Reference standard measures were (1) findings in dedicated
cross-sectional imaging obtained within 6 months from index
scan; (2) histopathologic diagnosis; or (3) clinical outcomes
obtained at least 3 years from the index scan. Imaging accuracy
was defined by the true positive (TP), true negative (TN), false
positive (FP) and false negative (FN) results.
Results: Out of 1430 imaging studies, 16 FP and 12 FN results
were identified, yielding an average delay of 235 days in
diagnosis. Most cases of inaccurate diagnosis of tumors were
noted in whole body magnetic resonance imaging (WB-MRI)
examinations. Sensitivity and specificity of tumor diagnosis
respectively were 0.96 and 1.0 for abdominal ultrasound, 1.0
and 0.85 for brain MRI, and 0.57 and 0.89 for skeletal lesions
identified by WB-MRI, respectively.
Conclusions: WB-MRI had relatively low sensitivity in early
tumor detection in patients with LFS. FN results were
responsible for delay in the diagnosis of tumors in specific
cases. Double reading by radiologists and understanding
potential sources of misdiagnosis may compensate for
perceptual inconsistencies in the detection of small tumors and
possibly increase diagnostic accuracy of WB-MRI by
minimizing FN results.
Paper #: 088
Doppler imaging in hypoxic ischemic encephalopathy: What
is the value of the resistivity index with and without
compression of the fontanel?
Erika Rubesova, MD1, [email protected]; Tuva
Sandgren2, Anton Flink Elmfors2, Valerie Chock, MD1, Alexis
S. Davis, MD1, Hans Ringertz, MD, PhD1; 1Stanford University,
Stanford, CA, 2Linköping University, Linköping, Sweden
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Ultrasound diagnosis of hypoxic
ischemic encephalopathy (HIE) remains challenging. Grayscale
diagnosis is limited by nonspecific findings such as increase of
echogenicity or loss of gray-white matter differentiation.
Previous studies have shown that the resistivity index (RI) value
is of poor reliability to predict outcome, especially in early
phases of HIE or under hypothermia treatment. Measurements
of the RI with gentle compression of the fontanel have been
suggested to stress the brain autoregulation in neonates with
abnormal intracranial compliance. We compared RI with
compression (wi/c) and without compression (wo/c) in babies
with and without HIE to define whether RI with compression
correlates better with HIE status.
Methods & Materials: 53 babies with clinically, cord and
blood PH and EEG proven HIE and 174 babies with normal
head ultrasound (GA 34-42 weeks) had head ultrasound with
measure of peak systolic and diastolic velocities, RI wi/c and
wo/c and RI delta (% difference in RI between wo/c and wi/c )
of the pericallosal artery. Ultrasound grayscale findings were
recorded. The RI was adjusted for GA, gender, and type of
delivery. Relationship between RI wi/c and wo/c with severity
of HIE was established and compared to normal values. RI for
each of HIE severity (mild, moderate,severe) were compared.
Ansari-Bradley and Fligner-Policello tests were used for
statistical analyses with a significance level of 0.05.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S107
Results: 40/53 grayscale US of HIE babies were reported
normal. There was no significant effect of gender, gestational
age on RI. Mean RI and dispersion of values of RI was
significantly different between HIE (mean=0.63, SD=0.13) and
normal babies wo/c (mean RI=0.66, SD=0.08), p=0.002 and
wi/c, HIE (mean=0.64, SD=0.12), normal (mean=0,68,
SD=0.09) Moderate and severe grades had significantly higher
variability in RI wo/c compared to mild grade (p=0.017). RI
wi/c was not significantly different among grades (p=0.32).
There was no significant effect on RI delta when comparing the
normal with HIE babies (p=0.45). RI delta was not significantly
different between the three groups of grades of HIE (p=0.30).
Conclusions: We report values of RI of the pericallosal artery
in babies with HIE and normal, for comparison. Babies with
HIE have different mean and a wider range of RI values than
normal babies whether the RI is performed with or without
gentle compression of the fontanel. The change of RI with
compression doesn’t help to differentiate HIE from normal
brain.
Paper #: 089
Region-Specific Perfusion Alterations in Neonatal Hypoxic
Ischemic Injury Evaluated with Arterial Spin Labeling
MRI
Qiang Zheng, Ph.D, [email protected]; Juan S. Martin-
Saavedra, MD, Minhui Ouyang, Sandra Saade-Lemus, MD,
Qinlin Yu, Hao Huang, Raymond Sze, Misun Hwang, MD;
Department of Radiology, Children's Hospital of Philadelphia,
Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To evaluate region-specific perfusion
alterations in neonatal hypoxic ischemic injury (HII) based on
pulsed arterial spin labeling (ASL) magnetic resonance imaging
(MRI) data as compared to controls.
Methods & Materials: The ASL perfusion data of 19 normal
neonates (10 male/9 female, 12 ± 6 days) and 31 HII neonates
with positive MRI findings (14 male/17 female, 9 ± 7 days)
were retrospectively evaluated. The cerebral blood flow (CBF)
maps were first calculated using the ASL data processing
toolbox (ASLtbx). From the CBF calculation results, averaged
region-specific perfusion values were extracted for comparison.
Specifically, the JHU neonate atlas was used to specify 130
brain regions for perfusion quantification. For accurate
comparison of each brain region, both CBF image and JHU
atlas were aligned to the subject-specific T2-contrast structural
image space. Permutation test was used to identify brain regions
with significant perfusion alterations between the control and
HII group with positive MRI findings.
Results: The experimental results identified 10 brain regions
significantly different in perfusion between the control and HII
groups based on the permutation test with p<=0.01.The brain
regions with the most significant perfusion alterations included
left/right precuneus (p=0.005/0.007), left/right superior occipital
gyrus (p=0.002/0.004), left/right cuneus (p=0.001/0.001),
left/right lingual gyrus (p=0.005/0.005), left/right cerebellar
hemisphere (p=0.001/0.003). Other than the region-specific
perfusion comparison, the whole brain comparison was also
implemented between the two groups by stacking all 130
average values of each brain region according to the JHU atlas.
The results also showed the significant difference in whole brain
perfusion (p<0.0001) with the average and standard deviation
value (ml/100g/min) to be 11.5±4.7 and 17.1±7.3 for the control
and HII groups, respectively.
Conclusions: The region-specific perfusion analysis based on
the brain ASL data can help identify brain regions most
significantly affected by the hypoxic ischemic injury. Further
studies are warranted to explore the prognostic implications of
perfusion alterations in these regions.
Paper #: 090
Changes in brain perfusion in successive arterial spin
labelling MRI scans in neonates with hypoxic-ischemic
encephalopathy
Maïa Proisy, M.D1, [email protected]; Isabelle
Corouge2, Antoine Legouhy2, Valerie Charon1, Amelie
Nicolas1, Nadia Mazille3, Stéphanie Leroux3, Bertrand
Bruneau1, Christian Barillot2, Jean-Christophe Ferré1; 1CHU
Rennes, Radiology Department, Rennes, France, 2Univ Rennes,
Inria, CNRS, INSERM, IRISA, VISAGES ERL U-1228,
Rennes, France, 3CHU Rennes, Neonatology Department,
Rennes, France
Disclosures: Maïa Proisy, M.D.: Research Grants: Société
Francaise de Radiologie, Région Bretagne (France). All other
authors have disclosed no financial interests, arrangements or
affiliations in the context of this activity.
Purpose or Case Report: The primary objective of this study
was to evaluate changes in cerebral blood flow (CBF) using
arterial spin labeling MRI between day 3 of life (DOL3) and
day 10 of life (DOL10) in neonates with hypoxic-ischemic
encephalopathy (HIE) treated with hypothermia. The secondary
objectives were to compare CBF values between the different
regions of interest (ROIs) and between infants with ischemic
lesions on MRI and infants with normal MRI findings.
Methods & Materials: We prospectively included all
consecutive neonates with HIE admitted to the neonatal
intensive care unit of our institution who were eligible for
therapeutic hypothermia. Each neonate systematically
underwent two MRI examinations as close as possible to day 3
(early MRI) and day 10 (late MRI) of life. A custom processing
pipeline of morphological and perfusion imaging data adapted
to neonates was developed to perform automated ROI analysis.
Results: Twenty-eight neonates were included in the study
between April 2015 and December 2017. There were 16 boys
and 12 girls. Statistical analysis was finally performed on 37
MRIs, 17 early MRIs and 20 late MRIs. Eleven neonates had
both early and late MRIs of good quality available. Eight out of
17 neonates (47%) had an abnormal early MRI and 7/20
neonates (35%) had an abnormal late MRI. CBF values in the
basal ganglia and thalami (BGT) and temporal lobes were
significantly higher on DOL3 than on DOL10 (p<0.05). There
were no significant differences between DOL3 and DOL10 for
the other ROIs. CBF values were significantly higher in the lobe
grey matter (GM) vs. the brain and in the BGT vs. the cortical
GM, on both DOL3 and DOL10 (p<0.05). On DOL3, the mean
CBF was significantly higher in the cortical GM, the BGT, and
the frontal and parietal lobes in subjects with an abnormal MRI
compared to those with a normal MRI (p<0.05). The perfusion
differences between subjects with an injury and those without
an injury on MRI had disappeared on the DOL10 scan.
Conclusions: This study is, to our knowledge, the first to
evaluate CBF on two successive scans within the first 15 days
of life in the same subjects in this clinical setting. ASL imaging
in asphyxiated neonates therefore seems more relevant when
used relatively early, in the first days of life. The correlation
with neurodevelopmental outcome warrants investigation in a
large cohort, to determine whether CBF values can provide
prognostic information beyond that provided by visible
structural abnormalities on conventional MRI.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S108
Paper #: 091
Quantitative ASL Perfusion Method for Detection of
Neonatal Hypoxic Ischemic Injury as Reference Standard
for Developing Contrast-Enhanced Ultrasound
Qiang Zheng, Ph.D, [email protected]; Juan S. Martin-
Saavedra, MD, Minhui Ouyang, Sandra Saade-Lemus, MD,
Qinlin Yu, Hao Huang, Raymond Sze, Misun Hwang, MD;
Department of Radiology, Children's Hospital of Philadelphia,
Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To develop a quantitative method for
detection of neonatal hypoxic ischemic injury (HII) based on
pulsed arterial spin labeling (PASL) magnetic resonance
imaging (MRI) perfusion data which can be served as a
reference standard for brain contrast enhanced ultrasound
(CEUS), a perfusion based ultrasound technique.
Methods & Materials: The ASL perfusion data of 19 controls
(10 male/9 female, 12 ± 6 days) and 31 neonates with HII and
positive findings on MRI imaging (14 male/17 female, 9 ± 7
days) were identified for retrospective analysis. After
calculating the cerebral blood flow (CBF) map from the ASL
data using the ASL data processing toolbox (ASLtbx), the
quantitative ASL perfusion ratios of central gray nuclei to white
matter (GNW) and central gray nuclei to cortex (GNC) were
compared between the control and HII groups by permutation
test. The perfusion ratios were calculated on the mid-coronal
plane as defined by the plane in which maximum cross sectional
area of the central gray nuclei is visualized. The mid-coronal
slice has previously been used for the wash-in time intensity
curve on brain CEUS, and the selection of this slice for ASL
quantification was based on the premise of developing a
reference standard for developing brain CEUS for diagnosis of
neonatal HII.
Results: Our results demonstrate that quantitative perfusion
ratios of GNW and GNC are significantly different between the
control and HII groups. Based on the permutation test, the white
matter of cingulum hippocampal part (p=0.013) and cerebral
peduncle (p=0.004) showed significant difference by GNW
comparison, and the cortex of superior temporal gyrus
(p=0.045), middle temporal gyrus (p=0.010), inferior temporal
gyrus (p=0.043), parahippocampal gyrus (p=0.006),
hippocampus (p=0.016), and insular cortex (p=0.008) showed
significant difference by GNC comparison. The ratios of central
gray nuclei to entire white matter, entire cortices, and all brain
regions on the middle coronal plane excluding gray nuclei were
also extracted for comparison, and the results revealed
significant group differences with p values of 0.035, 0.017, and
0.013, respectively.
Conclusions: Quantitative perfusion ratios can be used to detect
the presence of brain injury, which has critical implications for
developing perfusion-based ultrasound techniques including
brain CEUS. The utilization of quantitative perfusion ratios also
minimizes inter-subject and technical variability while allowing
subject’s own perfusion as internal control.
Paper #: 092
Contrast-enhanced ultrasound for the evaluation of
neonatal brain injury: Interpretation and implementation
Kayla Cort, DO, [email protected]; James Edgar, Jie C.
Nguyen, Hansel J. Otero, MD, Ann Johnson, Teresa Victoria,
MD, PhD, Ammie M. White, MD, Misun Hwang, MD;
Children's Hospital of Philadelphia, Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Contrast-enhanced ultrasound
(CEUS) is a new and promising modality for evaluating
neonatal brain injury through the detection of alterations in
perfusion. Qualitative and quantitative evaluation of perfusion
can be performed for diagnostic interpretation of brain CEUS
scans. As brain CEUS is a novel application, there are
challenges in implementing this into the clinical setting. We
explored whether a brief didactic session on the normal brain
CEUS perfusion pattern can improve radiologists’ interpretation
of brain CEUS scans.
Methods & Materials: Four attending pediatric radiologists
evaluated 6 CEUS mid coronal view cine clips of neonatal
brains demonstrating either normal perfusion or various patterns
of perfusion abnormalities over a two-day period. Findings on
all brain CEUS scans were confirmed by magnetic resonance
imaging. On a provided questionnaire, evaluators indicated if
each example was normal or abnormal (diagnosis). If an
abnormality was deemed present, evaluators specified the
distribution (focal, multifocal, diffuse), location (right
hemisphere, left hemisphere, bilateral hemispheres) and
perfusion characteristics (hypoperfused, hyperperfused). After
initial evaluation, a brief didactic session was provided,
demonstrating the normal neonatal brain perfusion pattern. On
the following day, participants reevaluated the same cases,
using the same questionnaire. Distribution of error pre and post
education was analyzed using McNemar testing for responses in
each of the following categories: diagnosis, distribution,
location and perfusion.
Results: The perfusion category showed 10 incorrect responses
pre education and 4 incorrect responses post education, p=0.07.
The diagnosis category showed 8 incorrect responses pre
education and 2 incorrect responses post education, p=0.07. The
location category showed 11 incorrect responses pre education
and 6 incorrect responses post education, p=0.18. The
distribution category showed 13 incorrect responses pre
education and 9 incorrect responses post education, p=0.22.
Conclusions: Preexisting familiarity with intravenous contrast
use and education on the normal neonatal brain perfusion
pattern on CEUS was insufficient to significantly alter exam
interpretation, although a trend toward improvement in all areas
was observed. This suggests that more familiarity with the
concept is warranted and that there is a potential benefit in
developing quantitative methods to be used in addition to
qualitative methods for detecting injury on brain CEUS.
Paper #: 093
Contrast-Enhanced Brain Ultrasound Perfusion Metrics in
the EXTra-uterine Environment for Neonatal Development
(EXTEND): Correlation with Hemodynamic Parameters
Ryne A. Didier, [email protected]; Anush Sridharan,
PhD, Kendall Lawrence, Barbara E. Coons, Marcus G. Davey,
Beverly G. Coleman, MD, Alan W. Flake; Children's Hospital
of Philadelphia, Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S109
Purpose or Case Report: Advancements in contrast-enhanced
ultrasound (CEUS) have allowed analysis of perfusion metrics
in various organs, including the brain. The influence of
hemodynamic parameters such as heart rate (HR), mean arterial
pressure (MAP), and blood flow have not been delineated. The
goal of this study was to assess for correlation between
hemodynamic parameters and perfusion metrics in CEUS of the
brain in fetal sheep maintained on the EXTra-uterine
Environment for Neonatal Development (EXTEND) system.
Methods & Materials: Following IACUC-approved protocols,
9 premature fetal lambs were transferred from placental support
to the EXTEND system. 0.1-0.3 mL Lumason® ultrasound
contrast was administered into the pumpless umbilical arterial to
umbilical venous oxygenator circuit at varying gestational ages
(93-133 days). Images were acquired as 90 second cine clips
using a GE Logiq E9 ultrasound system and C2-9 transducer
with settings optimized for contrast visualization. Clips were
analyzed with VueBoxTM post-processing software and time-
intensity-curves (TICs) were generated. Hemodynamic
parameters including HR, MAP, blood flow through the
oxygenator, pre-oxygenator oxygen level, oxygen delivery, pre-
and post-oxygenator pressure differential, and sweep
requirements across the oxygenator were recorded continuously
and averaged over the 90 seconds of imaging.
Results: A total of 86 CEUS examinations were performed, 72
of which were quantifiable and included in analysis. A
multilevel mixed-effects linear regression was performed with
random intercepts by subject. Hemodynamic parameters had no
effect on mean transit time (MTT), rise time (RT), fall time
(FT), or time-to-peak (TTP) (p>0.06). Sweep requirement and
oxygen delivery demonstrated an association with wash-in rate
(WIR), wash-out rate (WOR), wash-in area-under-the-curve
(WiAUC), wash-out AUC (WoAUC), wash-in-wash-out AUC
(WiWoAUC), and wash-in-perfusion-index (WiPi) (p<0.03).
Conclusions: CEUS perfusion metrics dependent on time
including MTT, RT, FT, and TTP are not correlated with
systemic hemodynamic data and any detectable changes in these
perfusion parameters reflects differences in localized blood
flow. None of the parameters need to be corrected for HR or
MAP. Perfusion parameters dependent on AUC quantification
including WiAUC, WoAUC, WiWoAUC, and WiPi are
correlated with sweep requirement and oxygen delivery and
these associations should be taken into consideration when
interpreting TIC results in future studies.
Paper #: 094
Artificial Intelligence Detection of Germinal Matrix
Hemorrhage on Head Ultrasound Examinations Using
Convolutional Neural Networks
Anushri Parakh, MD1, [email protected]; Chao
Huang1, Camilo Jaimes2, Hyunkwang Lee1, Synho Do1, Michael
S. Gee1; 1Radiology, MGH, Boston, MA, 2Boston Children’s
Hospital, Boston, MA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To evaluate the feasibility of
artificial intelligence detection of germinal matrix hemorrhage
(GMH) on neurosonograms using convolutional neural
networks (CNN).
Methods & Materials: In this HIPAA-compliant, institutional
review board-approved study, a single-institution radiology
report database was queried to identify neonatal head
ultrasounds (US) performed between January 2016-July 2018,
which were then categorized according to presence/absence as
well as the grade (I-IV based on the Papile classification) and
side of GMH. Static US images (gray-scale coronal and sagittal
views from the anterior fontanelle) from these exams were used
to train, validate, and test the CNN. From a total of 1000
images, 800 (n=400 each) served as the training dataset, 100
(n=49 for normal and n=51 for abnormal) as the validation
dataset, and 100 (n=51 for normal and n=49 for abnormal) as
the test dataset. Performance of the CNN was determined by
calculating sensitivity, specificity and accuracy based on the
clinical radiology report reference. Area under the receiver-
operating curve (AUC) was also obtained.
Results: A total of 387 US exams were identified, including 325
normal exams and 62 that were positive for GMH. The mean
corrected gestational age at the time of imaging for normal
studies was 38 weeks 3 days, compared with 30 weeks 6 days
for studies positive for GMH. In the 100 case test set, the
overall accuracy of CNN was 72% for GMH detection with an
AUC of 0.79. 44/51 normal cases were correctly classified
(specificity=86.3%). However, sensitivity was low (57.1%) with
a high false negative rate (28/49).
Conclusions: Artificial intelligence is currently not able to
detect GMH on head ultrasound examinations with acceptable
accuracy, primarily due to low sensitivity. This suggests that
ultrasound images may be less amenable to CNN training than
CT or radiographs due to decreased image contrast, and
reaffirms the primary role of human radiologists in head
ultrasound interpretation.
Paper #: 095
The Frontal Temporal and Frontal Occipital Horn Ratios in
Pediatric Hydrocephalus: Comparison and Validation of
Head Ultrasound with Volumetric Analysis via MRI
Rupa Radhakrishnan, MBBS MS1, Stephen F. Kralik, MD1,
[email protected]; Brandon P. Brown, MD, MA1,
Danielle Monn, MD2, Scott A. Persohn2, Paul R. Territo2,
Andrew Jea, MD1, Boaz Karmazyn, MD1; 1Radiology, Riley
Hospital for Children at Indiana University Health, Carmel,
IN, 2Indiana University School of Medicine, Indianapolis, IN
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Accurate measurement of ventricular
dimensions is crucial in infantile ventriculomegaly to guide
treatment. Although multiple methods of HUS ventricular
measurements exist, it is unclear if linear HUS measurements
are concordant with other imaging modalities and how they
correlate with ventricular volumes.Therefore, the purpose of this
study was to assess correlation between Frontal Occipital Horn
Ratio (FOHR) and Frontal Temporal Horn Ratio (FTHR)
indices obtained from HUS, with that of MRI, and to correlate
FOHR and FTHR with ventricular volumes.
Methods & Materials: We retrospectively included 100 infants
at < 3 months of age with ventriculomegaly who had head
ultrasound (HUS) and head MRI in a 3 day period without
interval intervention. Each study, HUS and MRI was reviewed
by 2 independent and blinded observers. Each observer
measured the FOHR (bifrontal horn dimension + bioccpital horn
dimension/ 2*biparietal diameter) and FTHR (bifrontal horn
dimension + bitemporal horn dimension/ 2*biparietal diameter).
MR images were used to calculate true ventricular and
intracranial volumes and the ratio of the ventricular to
intracranial volume (Vetricular volume ratio - VVR) was
calculated using Analyze software. Intraclass correlation
coefficients (ICC) and Bland Altman analyses were generated to
evaluate inter-observer concordance between a) the 2 HUS
observations, b) the 2 MRI observations, and c) between the
HUS and MRI observations for the FOHR and FTHR.
Correlation between the HUS and MRI FOHR and FTHR with
the VVR was assessed using Pearson correlation analysis.
Results: ICC showed excellent correlation between the two
reviewers in HUS FOHR (r=0.91), MRI FOHR (r=0.96) and
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S110
HUS FTHR (r=0.91) and good correlation for the MRI FTHR
index (r=0.86). ICC showed excellent correlation between the
HUS FOHR and MRI FOHR (r=0.84). ICC showed good
correlation between the mean HUS FTHR and MRI FTHR
(r=0.85). Bland Altman plots of the FOHR and FTHR between
mean observations of HUS and MRI showed excellent
agreement in both cases. VVR had high correlation with HUS
FHOR (r=0.87), MRI FOHR (r=0.85), HUS FTHR (r=0.83) and
MRI FTHR (r=0.79).
Conclusions: Frontal occpital horn ratio and frontal temporal
horn ratio indices obtained from ultrasound in infants with
ventriculomegaly show excellent inter-observer correlation,
correlate with MRI derived indices, and correlate with
ventricular volumes. This is therefore a promising tool for
future studies on management strategies in infantile
ventriculomegaly.
Paper #: 096
Incidence and Concordance of Suspected Intraventricular
Hemorrhage (IVH) on Fetal US and MRI in Open Spinal
Dysraphism with Postnatal Follow-Up
Ryne A. Didier, [email protected]; Juan S. Martin-
Saavedra, MD, Edward R. Oliver, MD, PhD, Suzanne E.
DeBari, RDMS, RVT, RT, Julie S. Moldenhauer, MD, Nahla
Khalek, Lori J. Howell, DNP, MS, RN, Gregory G. Heuer, N.
Scott Adzick, Beverly G. Coleman, MD; Children's Hospital of
Philadelphia, Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Ependymal nodularity, layering
debris, or susceptibility artifact can suggest intraventricular
hemorrhage (IVH) by fetal ultrasound (US) or magnetic
resonance imaging (MRI) in suspected open spinal dysraphism.
However, imaging findings overlap with grey matter heterotopia
(GMH). The goal of this study was to assess US and MRI in the
prenatal detection and characterization of IVH in open spinal
dysraphism and determine potential predictive factors that may
suggest IVH over GMH.
Methods & Materials: A retrospective, IRB-approved review
of pregnant patients referred to our institution for suspected
open spinal dysraphism from 1/2013-4/2018 was conducted.
Prenatal and postnatal US and MRI reports were reviewed for
findings of suspected IVH or GMH. Neonatal chart review was
performed to determine fetal or postnatal surgical intervention.
Results: 482 cases were confirmed to have open spinal
dysraphism by US with 467 corresponding fetal MRIs and 216
postnatal MRIs. Ependymal nodularity was seen in 133/467
(23.4%) and 130/467 (27.8%) of fetal US and MRIs,
respectively (κ=0.5). Suspected IVH was reported in 57/467
(12.2%) and 99/467 (21.2%) of fetal US and MRIs, respectively
(κ=0.5). Suspected GMH was reported in 73/467 (15.6%) and
88/467 (18.8%) of fetal US and MRIs, respectively (κ=0.56).
Increased lateral and third ventricular size as continuous
variables were both associated with suspected IVH by both US
and MRI (p<0.05) but not with IVH on postnatal MRI (p>0.07).
Even after excluding postnatal MRIs performed > 21 days of
age or after an intracranial intervention, IVH was seen in only
6/17 (35.3%) suspected by fetal US and 13/28 (46.4%)
suspected by fetal MRI. In this patient subset, when IVH was
seen on both US and MRI prenatally (n=11), subjects with IVH
on postnatal MRI demonstrated increased incidence of
persistent hindbrain herniation when compared to those without
IVH postnatally [83.3% (5/6) vs. 0% (0/5); p=0.02] despite
similar rates of fetal surgical intervention [67% (4/6) vs. 80%
(4/5); p=1.0].
Conclusions: Fetal US and MRI reported similar rates of IVH,
agreement between modalities was moderate, and concordance
with postnatal MRI findings was fair. Increased lateral and third
ventricular size may suggest IVH over GMH in the setting of
ependymal nodularity although evidence of IVH is infrequently
present on postnatal MRI. IVH may cause decreased
cerebrospinal fluid resorption leading to persistent hindbrain
herniation and continued evidence of blood products
postnatally.
Paper #: 097
Chest ultrasound for the screening and diagnosis of
pulmonary lymphangiectasia
Kayla Cort, DO, [email protected]; Hansel J. Otero,
MD, Christian A. Barrera, M.D., Erin Pinto, NP, Trudy
Morgan, Ammie M. White, MD, David Saul, Yoav Dori, MD,
PhD, David M. Biko, MD; Children's Hospital of Philadelphia,
Philadelphia, PA
Disclosures: David M. Biko, MD: Royalty: Wolters Kluwer.
All other authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Dynamic contrast enhanced MR
lymphangiography (DCMRL) is being increasingly used in
clinical practice to image the lymphatic system. However,
DCMRL is expensive, invasive and often requires sedation.
Recently, high resolution chest ultrasound of the lung surface
has been proposed as a bedside method for diagnosing
pulmonary lymphangiectasia (PL). We compare high resolution
chest ultrasound of the pleural surface to DCMRL in patients
with suspected PL.
Methods & Materials: We retrospectively reviewed the high
resolution chest ultrasound in children with suspected PL who
also had DCMRL. Transverse and coronal images in the upper,
middle and lower lung surfaces along the mid-axillary and
midclavicular lines were acquired on each side using a high
frequency (15mHz) linear transducer. The presence or absence
of lung surface irregularity, sub-pleural cysts, and pleural
effusions was documented. Correlation was made with
intranodal lymphatic contrast perfusion to the lung interstitium
or pleural space on DCMRL and the presence of interstitial
edema and pleural effusion on heavily T2 weighted imaging.
Results: 5 children (4 boys) between the ages of 1 month and 4
years old underwent both high resolution chest ultrasound and
DCMRL. Chest ultrasound and DCMRL were performed in
average 4.4 days apart (range 1 to 7 days). Four patients had
congenital heart disease and one had a primary lymphatic
disorder.4 of 5 patients had sonographic findings of PL
including lung surface irregularity (3 bilateral, 1 unilateral, 1
absent) and sub-pleural cystic spaces (1 bilateral, 2 unilateral, 2
absent). All 5 patients had pleural effusions (3 bilateral, 2
unilateral) on ultrasound. Similarly, at DCMRL 4 of 5 had
abnormal pulmonary lymphatic perfusion (3 bilateral, 1
unilateral, 1 absent). Interstitial edema (5 bilateral) and pleural
effusions (4 bilateral, 1 unilateral) were present on T2 weighted
imaging. US and DCMRL findings were in agreement in all 5
patients. Lung surface irregularity and sub-pleural cysts on
ultrasound correlated with abnormal pulmonary lymphatic
perfusion on DCMRL
Conclusions: High resolution chest ultrasound of the pleural
surface shows sonographic findings that correlate with findings
on DCMRL in patients with pulmonary lymphangiectasia. US
seems to be a promising modality for the screening of PL in
children to avoid invasive DCMRL.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S111
Paper #: 098
Contrast Enhanced Ultrasound (CEUS) Evaluation of
Thoracic Duct Outlet Patency After Percutaneous Injection
of Intranodal Contrast
David M. Biko, MD, [email protected]; Erika J. Mejia,
MD, Hansel J. Otero, MD, Christopher L. Smith, MD, PhD,
Molly Shipman, Mandi Liu, Erin Pinto, NP, Aaron G.
Dewitt, Jonathan J. Rome, MD, Yoav Dori, MD, PhD;
Department of Radiology, The Children's Hospital of
Philadelphia, Philadelphia, PA
Disclosures: David M. Biko, MD: Financial Interest: Wolters
Kluwer - Royalty: Editor of Review Book. All other authors
have disclosed no financial interests, arrangements or
affiliations in the context of this activity.
Purpose or Case Report: To evaluate the diagnostic accuracy
of contrast enhanced ultrasound (CEUS) for the evaluation of
thoracic duct (TD) patency following percutaneous intranodal
ultrasound contrast injection into the groin.
Methods & Materials: CEUS examinations of the left neck
following intranodal injection of ultrasound contrast (sulfur
hexafluoride lipid-type A microspheres) were retrospectively
evaluated for TD outlet patency by 2 blinded and independent
pediatric radiologists with experience in both lymphatic and
CEUS imaging. Inguinal lymph node access was obtained under
ultrasound guidance. CEUS exams were performed concurrently
with intranodal inguinal injection of contrast and imaged
continuously for 3-5 minutes or until contrast appeared. The TD
outlet was classified as patent or not patent by visualization of
lymphatic contrast passage into the venous system. Results were
correlated with conventional lymphangiography (when
available) which was reviewed independently and blinded by a
lymphatic interventionalist.
Results: 11 patients (9 male) who presented for lymphatic
evaluation were identified for the present study. Mean age was
4.4 years (range 2 months to 13.8 years). Of the 11 cases, the
TD outlet was patent on CEUS in 10 patients and not patent in
one. There was agreement between both CEUS readers on all
cases. 9 of 11 patients also had conventional lymphangiography
(8 of 9 on the same day, 1 within 6 months of CEUS). Of these
9 cases, the TD outlet was patent in 8 patients and not patent in
one on conventional lymphangiography. These patency results
matched the CEUS findings for each patient, thereby
demonstrating agreement in all 9 cases.
Conclusions: CEUS of the neck following intranodal inguinal
ultrasound contrast injection can accurately determine TD outlet
patency and can thus eliminate the need for conventional
lymphangiography when no percutaneous intervention is
needed.
Paper #: 099
Dual and Single Energy Pediatric Thoracic Computed
Tomographic Angiography: Effects on Radiation Dose and
Imaging Quality
Andrew B. Wallace, MD1, [email protected]; Juan Carlos
Ramirez Giraldo, PhD2, Marilyn J. Siegel, MD1; 1Mallinckrodt
Institute of Radiology, Saint Louis, MO, 2Siemens Healthineers,
Malvern, PA
Disclosures: Juan Carlos Ramirez Giraldo, PhD: JCRG is
scientist employed by Siemens. Marilyn J. Siegel, MD:
Financial Interest: JCRG is an employee of Siemens
Healthineers - Salary: JCRG is a senior key expert scientist
working for Siemens All other authors have disclosed no
financial interests, arrangements or affiliations in the context of
this activity.
Purpose or Case Report: The benefits of dual energy
computed tomography (DECT) over single energy computed
tomography (SECT) in thoracic computed tomographic
angiography (CTA) include automated bone removal, perfused
blood volume, and iodine mapping in patients with congenital
heart disease, arteriovenous malformations, trauma, and
thromboembolic disease; however, the radiation dose of DECT
must be considered. This study compares the image quality and
size-specific dose estimates (SSDE) of DECT and SECT in
pediatric thoracic CTA.
Methods & Materials: This institutional review board
approved, retrospective study included 109 children (median
age 7.5 years, 1 day to 17 years) who underwent DECT (n=53)
or SECT (N=56) thoracic CTA between September 2014 and
March 2018. DECT was performed on a Somatom Flash dual-
source scanner (Siemens) with 80 and 140 kVp. SECT was
performed at 80 kVp. Both DECT and SECT were performed
with automatic exposure control and iterative reconstruction.
SSDE was calculated based on effective chest diameter
determined by the patient's age. Image quality was subjectively
scored on a scale of 1 to 4 (1 excellent, 4 non-diagnostic). For
analysis, data were divided into four groups based on the
effective diameter, and two-sample t and Kruskal-Wallis tests
were performed.
Results: For the four size ranges of <15cm (group 1), 15-19cm
(group 2), 20-24cm (group 3), and >24cm (group 4); the median
(25th-75th quartiles) SSDE values for DECT were 2.2 (1.9-2.3),
2.1 (1.8-2.5), 3.4 (2.5-3.5), and 4.2 (3.6-5.1) mGy; respectively.
For SECT, the values were 2.2 (2.0-2.6), 2.1 (1.7-2.4), 2.0 (1.7-
2.3), and 4.1 (3.4-5.3) mGy, respectively. Doses were not
significantly different in groups 1, 2, and 4. In group 3, the
median SSDE was statistically higher for DECT (p<0.1).
Median patient age was similar between DECT and SECT in all
four groups. Subjective image quality was diagnostic in all
studies.
Conclusions: We have shown that in smaller children, DECT
thoracic CTA can be performed with a radiation dose that does
not exceed that of SECT while maintaining image quality.
Though dose was higher for DECT in some larger patients, this
may be due to small sample size. Regardless, DECT has several
advantages over SECT, which may outweigh a potential small
increase in radiation dose on a case by case basis. We suggest
that DECT can be introduced into routine practice for pediatric
thoracic CTA.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S112
Paper #: 100
Preoperative Visualization of the Artery of Adamkiewicz in
Pediatric Patients on Dynamic 4D airway CT angiograms
Donna Agahigian, RT(R)(CT),
[email protected]; Russell Jennings,
MD, Sanjay P. Prabhu, MBBS, FRCR; Boston Children’s
Hospital, Boston, MA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Preoperative artery of Adamkiewicz
(AoA) visualization is requested prior to surgery for
tracheobronchomalacia and thoracoabdominal tumors in
children as AoA injury can result in spinal cord injury. Unlike
in adults, MRA & CTA have not been successful in identifying
the AoA in pediatric patients, thereby necessitating more
invasive digital subtraction angiography (DSA) in some of these
patients.Purpose of this study was to determine whether the
AoA could be identified on dynamic 4D airway CT angiogram
studies in pediatric patients being performed for evaluation of
airway and esophageal anomalies.
Methods & Materials: We evaluated multiple phases of the
free breathing (sedated/non-sedated) dynamic 4D airway CT
angiograms performed for investigation of
tracheobronchomalacia on a dual energy CT scanner with
extended craniocaudal dynamic phase coverage below L1.
Image acquisition was initiated with peak descending aortic
enhancement (425 HU). Qblique coronal 1.3-1.5 mm thick
maximum intensity projections were reconstructed from the
phase where the AoA was identified as a hairpin curved vessel
in the anterior midsagittal surface of the spine. The AoA was
considered visualized if the “hairpin loop” of the artery within
the spinal canal was visible in addition to the anterior spinal
artery and the vessel could be traced to the intercostal artery by
paging through oblique coronal reformats. The vertebral body
above the level at which the spinal branch of the segmental
artery entered the spinal canal and continued as the AoA was
considered the level of AoA origin. The study radiologist
blinded to the official report reviewed all scans.
Results: Dynamic 4D airway CTs in 79 patients (43 male, 5
months-18 years) who underwent preoperative imaging for
airway anomalies were evaluated. Continuity between AoA and
aorta through intercostal or lumbar artery was confirmed in 67
(84%) patients. Level of origin of AoA was most frequent at
T10 and T11 (19 and 24 patients, respectively) but was also
found as high as C7. AoA was most commonly seen on
3rdacquisition (56%). Of 12 patients in whom all the criteria for
AoA were not fulfilled, the anterior spinal artery was visualized
in the lower spinal canal in 5 patients.
Conclusions: AoA can be identified in pediatric patients on
dynamic 4D airway studies with greater craniocaudal coverage,
optimal timing of scan acquisition and tailored multiphase data
processing. This information is valuable to surgeons and helps
avoid more invasive procedures like DSA.
Paper #: 101
CT Angiographic Findings of Pulmonary Arteriovenous
Malformations (PAVM) in Children with Hereditary
Hemorrhagic Telangiectasia (HHT): Spectrum of PAVM
and Correlation with Graded Transthoracic Contrast
Echocardiography (TTCE)
Su-Mi Shin1, [email protected]; Hee K Kim, MD2,
Katherine Wusik Healy2, Adrienne M. Hammill, MD, PhD2; 1Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea
(the Republic of), 2Cincinnati Children's Hospital Medical
Center, Cincinnati, OH
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Hereditary hemorrhagic
telangiectasia (HHT) is a genetic disorder. Pulmonary AVM
(PAVM) is one of the classic manifestations and may be
progressive in nature.The purpose of this study is to characterize
CT angiographic (CTA) findings of PAVM in children with
HHT and to correlate these with graded transthoracic contrast
echocardiography (TTCE).
Methods & Materials: A total of 40 patients (median age 14.9
years) with a diagnosis of HHT who had undergone both CTA
and TTCE were included. With CTA, PAVM was evaluated
based on location, distribution, and size. Each PAVM was
scored with a grading system being applied to conventional and
maximum intensity projection (MIP) images as follows:0 =
nodule, but unlikely AVM, 1 = ground glass opacity (GGO), 2 =
GGO with increased vascular network, 3 = GGO or nodule with
single draining vein, 4 = GGO or nodule with equally sized
afferent and efferent vessels, 5 = GGO or nodule with afferent
and asymmetrically enlarged efferent vessels, 6 = true AVM
with aneurysmal sac without the nodule or GGO. Total number
of PAVM, cumulative PAVM grading (adding up individual
PAVM grades), the highest grade given, total volume, and age
were recorded for each patient. TTCE was graded as per
Gazzaniga et al based on the number of bubbles (0 to 3) from
pulmonary right to left shunt and then correlated with the
variables of CTA and patient’s age (Pearson correlation).
Results: A total of 124 pulmonary lesions were identified on
CTA, including; peripheral (n=112), central (n=10), and both
(n=2); all the lesions were localized without diffuse form. The
CTA grading was increased on MIP images in 39 out of 124
PAVMs on conventional CT. The distribution of grades on MIP
included grade 0 (n=9), grade 1 (n=16), 2 (n=9), 3 (n=42), 4
(n=34), 5 (n=2), and 6 (n=12). The median size and volume
were 3.9mm and 31.1mm3 respectively. A statistically
significant correlation was seen between all variables of CTA
and TTCE (p<0.05), with the strongest correlation seen in those
with the CTA highest grading (r=0.79, p<0.0001). Age did not
correlate with any variables of CTA or TTCE grading.
Conclusions: In children with HHT, GGO or nodule with single
(grade 3) or two vessels (grade 4) were seen in two thirds of
cases. MIP images enabled more precise detection of the
afferent or efferent vessels. The highest grade in each patient
had the strongest correlation with the severity of pulmonary
right to left shunt. Unlike in adults, age was not an important
factor in determining the severity of PAVM in children.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S113
Paper #: 102
Predictive model for pediatric pulmonary embolism risk
utilizing semantic data mapping, neural embedding
technique, and recurrent neural network
David A. Mong, MD1, [email protected];
Imon Banerjee, PhD2, Matthew Lungren, MD MPH3; 1Children's Hospital Colorado, Denver, CO, 2Stanford
University, Palo Alto, CA
Disclosures: Matthew Lungren, MD MPH: Consultant,
Honoraria: Nines, Inc. All other authors have disclosed no
financial interests, arrangements or affiliations in the context of
this activity.
Purpose or Case Report: Risk factors and clinical presentation
of pediatric pulmonary embolism (PE) do not necessarily align
with adult populations, and standardized clinical likelihood
models have not been developed for children. Despite
increasing CTA utilization for evaluation of pediatric PE, the
rate of positive cases remains low, increasing exposure to
ionizing radiation secondary to lack of evidence-based clinical
imaging support guidelines. We propose a deep learning model
for estimating risk of PE in pediatric patients analyzing free-text
clinical notes.
Methods & Materials: After IRB approval, a retrospective data
base was collected including 5189 pediatric patients (1 month –
18 years, 2387 female, 2799 male, 1 unknown) seen at a tertiary
care pediatric hospital between 1/1/98 and 2/1/17 who had at
least one contrast enhanced chest CT exam in their electronic
medical record (EMR). EMR data collected up to one year
before CT included heterogeneous clinical notes (H&P, ED
notes, discharge), with temporal sequence maintained in the
data base. Semantic data mapping and neural embedding
technique were integrated in a single framework to produce an
unsupervised text summarization method for handling the
clinical notes. A many-to-one stacked recurrent neural network
(RNN) was designed to model temporal dependency of patient
visits with weighted categorical cross entropy loss function. The
RNN model was trained with Adam optimizer (learning rate =
0.001) and 100 batch size.
Results: The studied population had a total of 11744 chest CTs
and between 5 - 1400 clinical notes/patient. The database
contained 4% positive PE cases (545). 80% of reports were
randomly selected for training the neural network model and
20% for hold-out testing while maintaining patient-level
separation. Our model achieved 0.81 AUC-ROC on the 20%
hold-out test set.
Conclusions: The model predicts PE risk accurately with high
sensitivity, as well as returning most of positive PE cases (high
recall).
Paper #: 103
Artificial Intelligence Correction of Image Artifacts for
Faster Pediatric Lung MRI
David Y. Zeng, [email protected]; Dwight G.
Nishimura, Shreyas Vasanawala, MD/PhD, Joseph Y. Cheng,
PhD; Electrical Engineering, Stanford University, Stanford, CA
Disclosures: David Y. Zeng: Financial Interest: GE
Healthcare-Research Funding: Research; Dwight G.
Nishimura: Research Grants: GE Healthcare, Salary: GE
Healthcare (spouse); Shreyas Vasanawala, MD/PhD: Arterys,
Royalty: Arterys, GE Healthcare, Siemens, Philips, Research
Grants: GE Healthcare. Joseph Y. Cheng, PhD: Consultant,
Honoraria: HeartVista, Inc., Research Grant: GE Healthcare.
Purpose or Case Report: Pediatric MRI often involves
sedation or general anesthesia (S/GA) to minimize bulk and
respiratory motion to improve image quality, especially for
uncooperative patients. To minimize the duration and intensity
of S/GA and to potentially eliminate S/GA completely, rapid
imaging is essential. In this work, we enable rapid pediatric
chest imaging with a time-efficient 3D cones trajectory and
deep-learning off-resonance artifact correction.
Methods & Materials: A prospective study of 30 pediatric
chest magnetic resonance angiography exams (16 female; mean
age, 5.9 years; range, 0-17 years) was performed to train and
validate a residual convolutional neural network to correct off-
resonance artifacts (Off-ResNet). Each exam acquired a short-
readout scan (1.18msec ±0.38) and a long-readout scan
(3.35msec ±0.74) at 3T. Short-readout scans, with longer scan
times but negligible off-resonance blurring, were used as
reference images and augmented with additional off-resonance
for supervised training examples. Long-readout scans, with
greater off-resonance artifacts but shorter scan time, were
corrected by autofocus and Off-ResNet and compared to short-
readout scans by normalized root-mean-square error (NRMSE),
structural similarity index (SSIM), and peak signal-to-noise
ratio (PSNR). Scans were also compared by scoring on eight
anatomical features by two radiologists, using analysis of
variance with post-hoc Tukey's test. Reader agreement was
determined with intraclass correlation.
Results: Long-readout scans were on average 59.3% shorter
than short-readout scans (P<0.001). The proposed method had
superior NRMSE, SSIM, and PSNR compared to uncorrected
images across ±1kHz off-resonance (P<0.01). The proposed
method had superior NRMSE over -677Hz to +1kHz and
superior SSIM and PSNR over ±1kHz compared to autofocus
(P<0.01). Radiologic scoring demonstrated that long-readout
scans corrected with Off-ResNet were non-inferior to short-
readout scans (P<0.01).
Conclusions: The proposed method enabled scan time reduction
by 59.3% with longer readout durations, while maintaining non-
inferior image quality to diagnostically-standard scans,
suggesting viability of accelerating 3D cones trajectories for
pediatric imaging. Additional acceleration can be achieved by
combining parallel imaging and compressed sensing, both of
which pair well with acceleration from longer readout durations.
Paper #: 104
Imaging evaluation for thoracic spine fractures in pediatric
trauma patients: a single center experience at an academic
children’s hospital
Ala' Y. Ibrahim, [email protected]; Michael R. Aquino,
MD; Radiology, Hospital for Sick Children, Toronto, Ontario,
Canada
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Review epidemiology and imaging
work-up of thoracic spine fractures in pediatric trauma patients
over a 16-year period at an academic children’s hospital.
Determine the diagnostic performance of radiographs for
identifying thoracic spine fractures in the setting of trauma
Methods & Materials: This was a retrospective review of all
trauma patients ≤18-year-old that presented to an academic
children’s hospital between January 1, 2000 and December 31,
2016. A trauma patient database was used to identify all patients
with thoracic spine fractures. Recorded data included: patient
demographics, modality and results of imaging performed,
mechanism of injury, injury severity score(ISS), associated
injuries, management details, and patient’s outcome
Results: There were 3,265 trauma patients identified. Of these,
90 (3%) had thoracic spine fractures. The most common
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S114
mechanism of injury was “fall”, 39/90 (43%). Management for
thoracic spine fracture was required in 26/90 (29%) patients,
7/26 (27%) surgical. Thoracic spine fracture was significantly
associated with 1) the presence of a fracture at another spinal
level, 2) soft tissue spine injury, and 3) ISS. ISS as a predictor
of thoracic spine fracture resulted in sensitivity 77.6% (63.4 -
88.2) and specificity 57.1% (53.9-60.4) using a score >10 on the
receiver-operator curve. Radiographs were obtained in 85/90
patients with thoracic spine fractures. Of these, 75/85 had
additional imaging: 46/75 (61%) CT, 10/75 (13%) MRI, and
19/75 (25%) both CT and MRI. Three patients had both CT and
MRI only, and 1 patient had only CT. A total of 276 thoracic
fractures were detected in the 90 patients. The most common
fracture was simple compression fracture followed by transverse
process fracture. A total of 140/276 (51%) thoracic spine
fractures in 46/75 (61%) patients were not identified on
radiographs including 4/9 unstable fractures that required
surgical fusion (1/4) and brace (3/4). Three simple compression
fractures were missed by CT. MRI identified all fractures seen
on radiographs and CT.
Conclusions: Thoracic spine fractures are significantly
associated with the presence of other spine fractures and soft-
tissue injuries and increasing ISS. Radiographs have poor
sensitivity and can miss clinically significant fractures that
require surgical management.
Paper #: 105
Imaging Findings Following Button Battery Ingestions
Neil Grey, [email protected]; Peter E. DeWitt, Robert E.
Kramer, Lorna Browne, Angie L. Miller, LaDonna Malone,
MD; Pediatric Radiology, University of Colorado, Aurora, CO
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: The severity of button battery
ingestion (BBI) in children has been increasing since the early
2000s with outcomes ranging from mild localized inflammation
to fatal aortoesophageal fistula. Severe damage can occur in as
little as 2 hours after ingestion, and complications can have a
latency period of more than 2 weeks. Given the potentially for
severe outcomes, beginning in 2012 the authors’ institution
began performing serial MRI/MRAs of the chest on all BBI
patients after retrieval.
Methods & Materials: Following approval by IRB, we
conducted a retrospective review of all BBI cases between April
2012 and September 2018. Clinical history and endoscopic
findings were collected and all imaging studies were re-
reviewed. The degree and location of mediastinal inflammatory
change was graded and the presence of complications was
recorded: periesophageal, peritracheal and periaortic
inflammation as well as fistula, fluid collection, and vascular
injury.
Results: 23 patients with BBI had at least one MRI/MRA chest
for a total of 51 MRI/MRAs. The cohort was 70% male with
median age 2 years [0.94-17 y]. Severe complications were
encountered in 13 patients (57%) and included fluid collection
(n=11), tracheoesophageal fistula (TEF) (n=3), vocal cord
paralysis(n=1), and discitis(n=1). There were no patients with
vascular injury (0). TEF on MRI was graded as
negative/possible/probable with a sensitivity of 100% and
specificity of 85% vs. bronchoscopy. Location of the battery
was cervical esophagus in all but 1 patient with severe
complications (92%). Time from ingestion of BB did not
correlate with complications (p=0.65). All complications were
visualized on initial MRI performed in first 3 days following
retrieval. Subsequent serial examinations did not demonstrate
new latent complications (>1 week post retrieval) with a trend
to decreased mediastinal inflammation on serial imaging.
Conclusions: MRI after BBI demonstrates a high diagnostic
ability to identify the common associated complications
including fistula, fluid collection, and TEF. No conclusion can
be drawn regarding vascular injury risk as no patients in this
cohort had vascular injury. However, in clinical practice, the
detection of inflammation receding from the vascular structures
on serial MRIs provides invaluable information utilized to make
important management decisions. To our knowledge, this is the
first paper to report specifically on the MR findings after BBI.
Paper #: 106
Unreliability of standard fetal imaging biomarkers for
prediction of lethal pulmonary hypoplasia (PH)
Richard B. Parad, MD2, Deborah Stein, MD1, Ali Gholipour,
PhD1, Judy A. Estroff, MD1,
[email protected]; 1Radiology, Boston
Children’s Hospital, Boston, MA, 2Brigham and Women's
Hospital, Boston, MA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Assess survival and pulmonary
outcomes in a cohort of fetuses with severe oligohydramnios
who underwent maximal neonatal resuscitative efforts.
Methods & Materials: We evaluated 33 fetuses with severe
oligohydramnios, from any cause, seen in the prior 5 years at
either the Boston Children’s Hospital Advanced Fetal Care
Center or Brigham and Women’s Hospital Center for Fetal
Medicine, whose parents were counseled on risk of lethal
pulmonary hypoplasia based on prenatal sonographic findings
and who chose to have maximal neonatal resuscitative efforts at
birth. These efforts included immediate intubation, high
frequency ventilation, chest tube evacuation of pneumothoraces
and inhaled nitric oxide for pulmonary hypertension. A
retrospective medical record review compared fetal imaging
biomarkers associated with pulmonary hypoplasia (including
gestational age (GA) at onset of oligohydramnios, AFI,
presence/appearance of kidneys, presence of urine in the
bladder, appearance of lungs on MRI) in surviving and non-
surviving newborns.
Results: Standard imaging biomarkers did not reliably predict
poor outcome. Oligohydraminos was defined as AFI ≤ 5 cm or
deepest vertical pocket (DVP) < 2 cm; anhydramnios was
defined as absent amniotic fluid. Median GA at birth was 35.5
weeks. Intubation in the delivery room was required in 50% and
pneumothorax occurred in 50% of subjects. 77% of the cohort
survived to discharge home. Only 3/8 fetuses with
anhydramnios survived. Mean GA at onset and duration of
oligohydramnios did not differ significantly between survivors
and non-survivors. 6/7 deaths occured in the delivery room; 1
NICU death occured at 12 days. 6/7 subjects who died had
autosomal recessive polycystic kidney disease (ARPKD), all of
whom had large echogenic kidneys; however, 9/16 other fetuses
in this cohort also had ARPKD with large echogenic kidneys
and survived. 6/7 subjects who eventually had a renal transplant
did not require peritoneal dialysis. One subject is on dialysis
awaiting transplant. Of 2 infants with a prenatal diagnosis of
renal agenesis, one was found postnatally to have tiny dysplastic
kidneys, and survived to transplant. Of 7 infants with no fluid in
the bladder in utero, only 1 survived.
Conclusions: Standard imaging biomarkers did not reliably
predict survival. Fetuses can survive what is predicted to be
“lethal” oligohydraminios if aggressive neonatal resuscitation
takes place and renal replacement therapy is initiated. More
hopeful counseling than is currently presented may be
warranted.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S115
Paper #: 107
Attention-Aware Deep Learning Networks for Predicting
Gestational Brain Age Using Fetal MRI
Mahesh Atluri, DO2, [email protected]; Katie
Shpanskaya2, Lily H. Kim2, Quin Lu3, Safwan Halabi, MD2,
Beth M. Kline-Fath, MD1, Kristen W. Yeom, M.D.2; 1Cincinnati
Children's Hospital Medical Center, Cincinnati, OH, 2Stanford
University, Palo Alto, CA, 3Philips Healthcare NA, Gainesville,
FL
Disclosures: Quin Lu, PhD: Salary: Philips. All other authors
have disclosed no financial interests, arrangements or
affiliations in the context of this activity.
Purpose or Case Report: Given the dramatic structural
changes of fetal neurodevelopment, precise knowledge of
gestational age and the associated neuroanatomical hallmarks is
key to the accurate interpretation of the fetal brain MRI. In this
study, we aim to develop and validate a novel deep learning
approach to accurately predict gestational age from fetal brain
MRI.
Methods & Materials: We retrospective reviewed all fetal
MRIs acquired by our institution from 2004-2017. Normal brain
development was assessed by a rigorous review of each study
firstly by review of the initial radiology report followed by
further evaluation of the fetal brain images by an expert
pediatric neuroradiologist. Gestational age was calculated using
the current obstetric standard of care approach that references
the estimated date of delivery recorded at the first-trimester
ultrasound. The robust database of 855 normal fetal brain MRIs
was distributed across training (70%), validation (10%) and
testing (20%) sets for experimental evaluation. We developed a
novel attention-aware deep learning network consisting of two
convolutional neural networks (CNNs) working in parallel to
combine whole slice image features with brain-specific features,
derived from engineered attention maps. This innovative
approach mimics the expert neuroradiologists' behavior,
allowing a rotation-invariant auto-detection of the fetal brain
and thus boosting the prediction outcomes. Regression model
performance was evaluated by the R2 statistic.
Results: Our attention-aware model achieved strong predictive
performance (R2 = 0.93, Mean error = 7.4 days) of gestational
age using multi-plane fetal MRI. Single-plane prediction of
gestational age achieves an R2 of 0.88 (axial), 0.87 (coronal),
and 0.83 (sagittal) with attention-map guidance. A standard
CNN without attention enhancement was able to retain high R2
of 0.83, 0.84, and 0.81 for the corresponding axial, coronal, and
sagittal MRI planes, respectively.
Conclusions: Deep neural networks can accurately characterize
healthy in utero brain development from fetal MRI. Clinical
translation of such insights has the potential to improve early
detection of normal and abnormal fetal brain maturation. The
proposed deep learning algorithm could serve as an adjunct
diagnostic tool in evaluating appropriate fetal
neurodevelopment on MRI.
Paper #: 108
Inner and external ear malformations as assessed on fetal
ultrasound and MRI
Jungwhan J. Choi, M.D.,
[email protected]; Caroline Robson, MB
ChB, Judy A. Estroff, MD; Radiology, Boston Children's
Hospital, Boston, MA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Previous literature has documented
associations between external ear abnormalities with syndromes
as assessed on ultrasound. The purpose of this study is to review
abnormalities of the inner and external ears as assessed on
ultrasound and 3T fetal MRI and to document their association
with syndromes, thus better informing patients, clinicians,
genetic counseling and workup.
Methods & Materials: An IRB approved retrospective review
was performed of fetal ultrasound and MRI examinations
performed between 8/1/2013-8/1/2018. Examinations were
reviewed for the presence of malformations of the inner and /or
external ears. When available, genetic testing and postnatal
clinical documents and imaging were also reviewed.
Results: From the dates of 8/1/2013-8/1/2018, 41 pregnant
females were imaged in whom ear malformations were
observed in their fetuses. The most commonly observed external
ear malformations included malformed pinnae (n = 20)
including microtia (n = 9); low set ears (n = 17); external
auditory canal malformation or atresia (n = 9); mass involving
or abutting the external ear (n = 4, most commonly lymphatic
malformations); preauricular skin tags (n = 3); and anotia (n =
2). The most commonly observed inner ear malformations
included cochlear malformation (n = 6); absence and / or
malformation of the semicircular canals (n= 4); vestibular
malformation (n = 3); malformed internal auditory canals (n =
3); and absence of the inner ear structures (n = 1). Ear
abnormalities were associated with syndromes on the basis of
additional imaging findings, genetic testing and / or postnatal
examination in a large number of cases (18/41) with the most
commonly observed syndromes including CHARGE (n = 4),
Trisomy 18 (n = 3), Trisomy 13 (n = 3), 22q11.2 duplication (n
= 2), Brachio-Oto-Renal syndrome (n = 1), Trisomy 21 (n = 1),
Trisomy 22 (n = 1), Goldenhar syndrome (n = 1), Klinefelter
Syndrome (n = 1), and Cat-Eye Syndrome (n = 1). Syndromic
associations were suggested in 5/41 cases, but were not
confirmed due to redirected care. Vascular anomalies counted
for 4/41 cases involving the external ear. In the remainder of the
ear malformations, no syndromic correlation, genetic
abnormality or unifying diagnosis was made.
Conclusions: Our findings suggest that detailed evaluation of
the inner and external ears should be performed in every
evaluation of the fetus and malformation may suggest the
presence of underlying syndromic condition.
Paper #: 109
Comparison of SAR and SED between fetal MR imaging at
1.5T and 3T: Our experience with 3247 examinations
Christian A. Barrera, M.D.1, [email protected];
Michael L. Francavilla, MD1, Suraj Serai1, James Edgar1,
Camilo Jaimes2, Michael S. Gee3, Teresa Victoria, MD, PhD1; 1Radiology, The Children's Hospital of Philadelphia,
Philadelphia, PA, 2Boston Children's Hospital, Boston, MA, 3Massachusetts General Hospital, Boston, MA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S116
Purpose or Case Report: To compare and contrast the Specific
Absorption Rate (SAR) and Specific Energy Dose (SED) of
fetal MR examinations obtained at 1.5T and 3T magnet
strength.
Methods & Materials: All fetal MRIs performed on 1.5T and
3T scanners from 2012 to 2016 were included. Patients with
incomplete clinical information and with prematurely halted
studies were excluded. Sequences performed include Steady
State Free Precession (SSFP), Single Shot Fast Spin Echo
(SSFSE), T1-weighted Spoiled Gradient Echo 2D (SPGR),
SPGR 3D (SPGR-3D), SSFP 3D (SSFP - 3D) Echo Planar
Imaging (EPI), and SSFP Cine. The SAR (W/kg) and
acquisition time values were retrieved from the DICOM header.
The SED (J/kg), which reflects the sum of energy absorbed by
the patient in the course of the MRI examination, was calculated
as the SAR multiplied by the acquisition time in seconds. The
accumulated SED is the sum of energy absorbed by the patient
in the course of the MRI examination. Descriptive data is
presented as mean ± SD. Independent-sample t-test was used.
Effect sizes (Cohen's d) were calculated and classified as: small
between 0.20 – 0.50, medium between 0.5 – 0.8 and large at
0.80 or greater. A p-value < 0.05 was considered significant.
Results: 3247 fetal MRIs were included: 2784 at 1.5T and 463
at 3T. The mean maternal age, gestational age and weight were
29.8 ± 5.7 years, 24.4 ± 5.7 weeks and 78.1 ± 19.4 kg,
respectively. In total, 93,764 sequences were retrieved for
analysis: 81,535 performed at 1.5T and 12,229 at 3T. The mean
acquisition time was shorter at 1.5T (25.1 ± 13.2 sec) than 3T
(30.2 ± 13.9 sec), p < 0.001. Significantly higher SAR was
observed at 3T (1.1 ± 0.6) than 1.5T (1.0 ± 0.6) (d = 0.06, p <
0.001). Mean SED per sequence was higher at 3T (37.7 ± 25.6)
than 1.5T (32.9 ± 26.7) (d = 0.17, p< 0.001). Accumulated SED
collectively did not show a difference between 1.5T and 3T
(965.1 ± 408.1 vs 996.1 ± 365.6, d = 0.07, p = 0.12). The
following sequences demonstrated a higher SAR at 3T than at
1.5T (p < 0.001): EPI (0.2 vs 0.1), SPGR (1.1 vs 0.4), SSFP-3D
(1.5 vs 1.4) and SSFP Cine (1.6 vs 1.5). The following
sequences demonstrated a higher SED at 3T than 1.5T (p <
0.001): EPI (8.3 vs 2.0), SSFSE (55.9 vs 50.8), SPGR (26.1 vs
9.5), SSFP (45.7 vs 35.7), SSFP-3D (27.0 vs 16.5) and SSFP
Cine (58.2 vs 56.2).
Conclusions: Fetal MRI performed at 1.5T and 3T scanners
share similar energy deposition metrics. Although some
differences were observed between 1.5T and 3T, the effect sizes
indicate that the differences were very small.
Paper #: 110
Determination of Placental Fractional Blood Volume in a
Pregnant Mouse Model
Andrew A. Badachhape, Ph.D., [email protected]; Laxman
Devkota, PhD, Igor Stupin, M.D. / Ph.D., Mayank Srivastava,
Ph.D., Poonam Sarkar, Ph.D., Ketan B. Ghaghada, PhD, Eric
Tanifum, Ph.D., Ananth Annapragada; Radiology, Baylor
College of Medicine / Texas Children's Hospital, Houston, TX
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Greater than 60% of placentae from
low birth weight infants show signs of hypoxic or ischemic
injury from vascular hypo-perfusion. Placental fractional blood
volume (FBV) is indicative of perfusion and may be used as a
marker of local ischemia. Non-invasive methods for the
estimation of placental FBV are therefore of interest in the study
of placental pathologies. In this pre-clinical study, we
investigated contrast-enhanced magnetic resonance imaging
(MRI) for the estimation of placental FBV in a pregnant mouse
model. A high T1 relaxivity blood-pool liposomal-gadolinium
(liposomal-Gd) contrast agent, which does not permeate
placental barrier in rodents, was used for the determination of
placental FBV.
Methods & Materials: In vivo studies were performed in
pregnant C57BL/6 mice (8-10 feto-placental units per dam).
MRI was performed on a 1T scanner at day 18 of gestation. Pre-
contrast and post-contrast images were acquired using a T1-
weighted 3D gradient-recalled echo sequence. Post-contrast
images were acquired following intravenous administration of
liposomal-Gd (0.1 mmol Gd/kg). A variable flip-angle method
was used to determine T1 relaxation time and relaxation rates in
the placenta (R1P=1/T1P) and the inferior vena cava
(R1IVC=1/T1IVC). Differences between pre-contrast and post-
contrast R1 values were determined in the placenta (ΔR1P) and
IVC (ΔR1IVC). MRI-derived placental FBV was calculated as a
ratio of R1 differences in the placenta to IVC: FBVMRI =
ΔR1P/ΔR1IVC. Contrast-enhanced CT (CECT), where signal is
proportional to concentration of iodine contrast agent, was used
for validation of MRI-derived FBV. CT scans were performed
on a small animal micro-CT scanner. CECT was performed
after intravenous administration of a liposomal-iodinated agent
(1.1 g I/kg). CT-derived placental FBV (FBVCT) was calculated
as the ratio of signal enhancement in placenta to IVC.
Results: The long circulating property of liposomal-Gd resulted
in uniform vascular signal enhancement. T1 relaxation time
reduced nearly four-fold in the IVC (pre-contrast T1IVC = 1230 ±
50 ms; post-contrast T1IVC = 310± 25 ms). In the placenta, T1
relaxation times decreased three-fold (pre-contrast T1P = 1870 ±
150 ms; post-contrast T1P = 540 ± 70 ms). MRI-derived
placental FBV was computed as 0.55 ± 0.07 and showed good
agreement with values derived from CT (FBVCT = 0.52 ± 0.03).
Conclusions: Contrast-enhanced MRI using a liposomal-Gd
blood-pool contrast agent enables accurate determination of
placental fractional blood volume.
Paper #: 111
Growth Recovery Lines: A Specific Indicator of Child
Abuse and Neglect?
Lora Spiller, MD1, [email protected]; Nancy Kellogg,
MD1, Maria-Gisela Mercado-Deane, MD2, Anthony I. Zarka,
D.O.2, Jonathan Gelfond, MD, PhD1; 1University of Texas
Health San Antonio, San Antonio, TX, 2Children's Hospital of
San Antonio, San Antonio, TX
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: The purpose of this study was to gain
an understanding of the distribution, quantity, and associations
of growth recovery lines (GRLs) in children from 0 to 24
months of age with high and low risk for child maltreatment.
Methods & Materials: We performed a retrospective cohort
study of children from 0 to 24 months who had skeletal surveys
and an assessment regarding the level of concern for
maltreatment. Two pediatric radiologists blinded to the abuse
likelihood independently counted the number of GRLs at each
proximal and distal bone site of the extremities. A GRL was
defined as a radiodense band traversing parallel to the
metaphysis involving at least 50% of the width of the
metaphysis. Subjects were classified into 1 of 3 groups: low risk
(no findings of abuse or neglect on examination), physical
abuse, and neglect. Assessments were conducted by at least one
child abuse pediatrician prior to the radiologists’ review. The
demographic data (age in months and gender) and the key
outcomes (total number of GRLs in each subject and number of
bone sites with GRLs) were tested for association with the risk
group variable using Chi-squared and ANOVA.
Results: Of the 135 children in this study, 58 were in the low
risk group, 26 were in the neglect group, and 51 were in the
physical abuse group. Children in the neglected and physically
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S117
abused groups had 1.73 (p = 0.007) times and 1.84 (p < 0.001)
times more GRLs than the low risk group, respectively. The
specificity for maltreatment in subjects with at least 10 GRLs in
the long bones was greater than 84% [range 84% to 95%], while
the sensitivity was less than 35% [range 25% to 35%]. The most
common location for GRLs in abused children was the distal
radius, followed by the proximal and distal tibia.
Conclusions: The presence of at least 10 GRLs in the long
bones of children between 0 and 24 months of age is highly
specific for maltreatment in the absence of another identified
stressor. It is important to note that these findings most likely
represent previous episodes of unidentified maltreatment, rather
than the incident that resulted in their identification as a victim.
This was the first study to identify the distal radius as the bone
site most likely to have GRLs in physically abused children. X-
rays with multiple growth recovery lines should raise concern
for child abuse and neglect.
Paper #: 112
Establishing signs for acute and healing phases of classic
metaphyseal lesions
Dilek Saglam, MD2, Megan B. Marine, MD1, Matthew R.
Wanner3, Roberta Hibbard, MD1, Greg Jennings3, Boaz
Karmazyn, MD1, [email protected]; 1(3) Department of
Pediatrics, Indiana University School of Medicine, Riley
Hospital for Children, Section of Child Protection Programs,
Indianapolis, IN, 2Malatya Education and Research Hospital,
Malatya, Turkey, Turkey, 3Department of Radiology and
Imaging Sciences, Indiana University School of Medicine,
Indianapolis, IN
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To analyze changes in distal tibial
CMLs within 2 weeks follow-up to establish stages of healing.
Methods & Materials: From 2009 to 2018 we identified all
skeletal surveys with a diagnosis of distal tibia CML with 2
week follow-up survey. Our routine skeletal survey includes AP
and lateral radiographs of the long bones. The surveys were
reviewed independently by two pediatric radiologists. Likert
score from 1 to 5 (1=no CML, 5=definite CML) was used. Only
cases with a Likert score of 4 or 5 by both radiologists were
selected.Demographic, clinical, and imaging findings were
recorded. One radiologist reviewed all CMLs at initial and 2
week follow-up skeletal survey for presence of the following
signs: corner fracture, thin bucket handle fracture (BHF), thick
BHF, BHF with endochondral bone filling the gap (BHFG),
subphyseal lucency (SPL), increased metaphyseal density
(IMD), deformed corner (DC), and subperiosteal bone
formation (SPBF).We hypothesized that findings seen only on
initial surveys represent acute phase signs. Any signs seen on 2
week follow-up represent healing phase.
Results: The study group included 25 children (12 females)
with age range 1-12 months (mean 3 months). 22/25 (88%)
children had other fractures.34 distal tibia CMLs were analyzed
(right 18, left 16). Thin BHF (n=19, 56%) and isolated corner
fractures (n=2, 6%) were only seen on initial skeletal survey and
therefore were determined to represent signs of acute phase
(n=21). On follow-up, most (n=11, 52%) had thick BHF and
others had BHFG (n=3, 14%), DC (n=6, 29%), or were normal
(n=1, 5%).12 cases of thick BHF (n=7) or BHFG (n=5) were
noted on initial surveys. six of them had corner fractures. On
follow-up, 3 (25%) had DC and 7 (58%) were normal. None of
these demonstrated thin BHF on follow-up.The following signs
of healing CMLs were seen in the initial (n=12) and follow-up
(n=34) series; IMD (n=7, 15%), DC (n=6, 13%), and SPL (n=4,
9%). SPBF was not evaluated in five patients with concomitant
other tibial fractures and was seen in 49% (20/41) of the
fractures in the healing phase.
Conclusions: Our findings suggest that thin BHF is the most
common finding of acute CML fractures. Acute CMLs most
commonly progress to thick BHF. SPBF is seen in about half of
the healing CMLs. Other findings of healing CML are BHF
with endochondral bone filling the gap, increased metaphyseal
density, corner deformity and subphyseal lucency. Normal
metaphysis on 2-week follow up does not exclude CML as it
was seen in about one-fifth of cases.
Paper #: 113
A Systematic Review of Radiographic Time Since Injury
Methods for Pediatric Healing Fractures
Diana L. Messer, MS1, [email protected]; Brent Adler,
MD2, Farah Brink, MD2, Henry Xiang, MPH, PhD, MD2,
Amanda Agnew, PhD1; 1The Ohio State University, Columbus,
OH, 2Nationwide Children's Hospital, Columbus, OH
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: In physically abused children,
fractures often go undetected; in such cases, time since injury
(TSI) estimation may be essential for identification of abuse as
well as prevention of continued violence. The present study was
designed to systematically review empirical studies of
radiographic methods to assess TSI of healing fractures in
pediatric patients. These methods were evaluated for their utility
in clinical as well as forensic settings, with particular concern
for child protection.
Methods & Materials: A systematic literature search was
performed of EBSCO, Embase, MEDLINE (PubMed), and Web
of Science for scientifically-based radiographic methods to
assess TSI published from the earliest available through August
6, 2018. After screening 4,549 articles, this search identified
eleven empirical studies of pediatric fracture healing that met
study inclusion criteria.
Results: Of eleven articles, seven were based on samples of
patients less than one year old while four articles combined
patients of varying ages. Seven articles based their timelines on
pooled fracture locations, of which six included fractures of the
upper and lower limb; only two examined differences in healing
based on fracture location. Two articles focused on abuse-
related fractures while many articles failed to exclude abuse-
related fractures. Inconsistencies in fracture healing variables
exist across articles, which limits many direct associations.
When comparisons can be made, healing timelines vary
between articles, potentially in part due to the retrospective
nature of the research. Though several articles mentioned that
the methods and associated timelines could be applied to
fracture locations other than those used in their study, few
validation studies exist. In addition, the appropriateness of
applying fracture healing timelines derived from accidental
fractures to abuse-related fractures has not yet been explored.
Conclusions: TSI methods applied to fracture locations and
patients with ages other than those the method was developed
from could provide inaccurate estimates of fracture healing.
Research into patient age, fracture location, and abuse status on
fracture healing must be further examined before new methods
are developed. It is suggested that methods derived from pooled
patient age populations as well as pooled fracture locations
(especially those derived from combined upper and lower limb
fractures) be used with caution until otherwise substantiated for
broader use.
Paper #: 114 - Withdrawn
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S118
Paper #: 115
Morphometry of a tissue engineered vascular graft (TEVG)
by multimodality imaging including MRI, intravascular
ultrasound and angiography in a translational sheep model
John M. Kelly, MD, [email protected];
Ramkumar Krishnamurthy, PhD, Houchon Hu, Jason Zakko,
Kevin Blum, Jacob Zbinden, Yuichi Matsuzaki, Kejal Shah,
Toshiharu Shinoka, Christopher Breuer, Rajesh Krishnamurthy,
Kan Hor, M.D.; Pediatric Cardiology, Nationwide Children's
Hospital, Columbus, OH
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: First-in-human studies by our group
have demonstrated the successful implantation of a
biodegradable polymer based tissue engineered vascular graft
for use in the treatment of children with complex congenital
heart disease. However, widespread adoption is limited by
potential complications including aneurysmal dilatation,
infection, calcification and stenosis. In this translational study
on sheep, we utilized MRI, intravascular ultrasound (IVUS) and
conventional angiography (CA) to evaluate graft morphometry
and blood flow properties across the graft in the near-term.
Methods & Materials: 2 cm long TEVGs, assembled by
seeding autologous bone marrow derived mononuclear cells
onto a biodegradable tubular scaffold of polyglycolic acid and a
50:50 copolymer of poly(actide-co-glycolid), were implanted in
the intrathoracic inferior vena cava of juvenile sheep (n=8).
Animals were evaluated at 1 week and 6 weeks post
implantation with CA, IVUS, black blood TSE MRI, contrast
enhanced 3D radial MR angiography (MRA), MR 2D and 3D
flow velocity mapping, and delayed enhancement imaging for
fibrosis. In each subject, native IVC before and after the graft,
proximal and distal graft anastomotic sites, and the mid graft
were analyzed on all 3 modalities, and compared between
weeks 1 and 6. Patterns of luminal distortion were assessed, and
characterized using flow velocity changes, turbulence, energy
loss, and tissue response as demonstrated on dynamic early
contrast enhancement (DCE), and delayed enhancement (DE).
Results: MRA yielded excellent morphometric definition of the
native and grafted vasculature for luminal caliber and distortion
when compared to angiography. There was good correlation
between measurements of graft thickness obtained by IVUS and
TSE. Some degree of stenosis was noted in all subjects with
anastomotic and whole graft involvement, while there were no
cases of rupture, aneurysm formation or infection. Unique
information obtained from MRI included area deformation of
the TEVG throughout the cardiac cycle, flow alterations and
collateralization related to stenosis, estimates of wall shear
stiffness and power loss, and estimate of host response at 1 and
6 weeks based on DCE and DE of the graft wall.
Conclusions: MRI/MRA provides comprehensive assessment
of TEVG by providing information on luminal architecture, wall
thickness, graft integrity, flow perturbations and energy loss,
which will be used to develop computational models to predict
tissue engineered graft remodeling and stenosis.
Paper #: 116
Intrahepatic Dynamic Contrast Enhanced MR
Lymphangiography: A New Technique for Visualization of
the Central Lymphatics
David M. Biko, MD, [email protected]; Christopher L.
Smith, MD, PhD, David Saul, Hansel J. Otero, MD, Ammie M.
White, MD, Mandi Liu, Molly Shipman, Erin Pinto, NP, Aaron
G. Dewitt, Jonathan J. Rome, MD, Yoav Dori, MD, PhD;
Dept. of Radiology, The Children's Hospital of Philadelphia,
Philadelphia, PA
Disclosures: David M. Biko, MD: Financial Interest: Wolters
Kluwer - Royalty: Editor of Review Book. All other authors
have disclosed no financial interests, arrangements or
affiliations in the context of this activity.
Purpose or Case Report: Dynamic contrast enhanced MR
lymphangiography (DCMRL) is a well described technique of
imaging the central lymphatics following intranodal contrast
injection. Intrahepatic dynamic contrast enhanced MR
lymphangiography (IH-DCMRL) involves ultrasound guided
injection of a gadolinium contrast agent into the intrahepatic
lymphatic ducts followed by MRI of the chest and abdomen
with dynamic time resolved and delayed imaging. We aim to
describe the MRI findings of IH-DCMRL.
Methods & Materials: Imaging of all patients less than 20
years of age who underwent an IH-DCMRL over 6 months was
retrospectively and independently reviewed by 2 blinded
pediatric radiologists who subspecialize in lymphatic imaging.
Initially, success of intrahepatic lymphatic access and injection
was evaluated. Imaging finds such as pericholecystic
enhancement, mesenteric and retroperitoneal reflux, and
visualization of the thoracic duct (TD) was assessed. Presence
or absence of abnormal lymphatic perfusion to the peritoneal
cavity, bowel, and lung and hila was determined. Images were
also evaluated for hepatic vein contamination and peritoneal
contamination. Disagreements between the 2 readers were
solved by consensus. A chart review was performed for
demographics and history.
Results: A total of 21 patients (10 male) with a mean age of 7.4
years (range 4 months to 16.9 years, interquartile range 13.1
years) were identified. Clinical indications included pleural
effusion (n=11), ascites (n= 7), protein losing enteropathy
(PLE,n=6), anasarca (n=2), and intestinal lymphangiectasia
(n=1). Two (10%) IH-DCMRLs were technically unsuccessful
due to needle displacement. Pericholecystic enhancement (n=7)
and reflux into the mesenteric (n=17) and retroperitoneal
lymphatics (n=17) was present. Abnormal lymphatic perfusion
to the peritoneal cavity (n=7), bowel (n=7), and lung (n=11) was
seen. Readers were in agreement on the presence or absence of
lymphatic perfusion to the peritoneal cavity in all cases, in
18/19 cases of perfusion to the bowel, and in 17/19 cases of
perfusion to the lung and hila. The TD was visualized in 15/19
patients (79%). Hepatic vein contamination was common
(n=14). Peritoneal contamination occurred in 3 patients, 2 of
which were unsuccessful IH-DCMRLs.
Conclusions: IH-DCMRL is a promising technique to evaluate
the liver and central lymphatics which may be advantageous
when lymphatic imaging via an intranodal approach is
ineffective in demonstrating these lymphatic pathways.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S119
Paper #: 117
Evaluation of Cumulative Perimetric Ratio as Quantitative
Index for Degree of Left ventricular Myocardial
Trabeculations in Adolescents and Young Adults
Amol Pednekar, PhD, [email protected];
Siddharth P. Jadhav, MD, Cory Noel, MD, Prakash M. Masand,
MD; Radiology, Texas Children's Hospital, Houston, TX
Disclosures: Prakash M. Masand, MD: Consultant,
Honoraria: Canon Medical Systems, Phillips MRI Users
Meeting 2018, Daiichi Sankyo, Speakers Bureau: Canon
Medical Systems, Royalty: Amirsys. All other authors have
disclosed no financial interests, arrangements or affiliations in
the context of this activity.
Purpose or Case Report: Cumulative perimetric ratio (CPR)
serves as a quantitative index of irregularity and sparsity of the
left ventricular (LV) trabecular structures in bright blood cine
balanced steady-state free precession (bSSFP) MR images. The
purpose of this abstract is to evaluate CPR as a 2D geometric
measure complimentary to morphometric measures like non-
compacted (NC) to compacted (C) length ratio (LR) and mass
ratio (MR) in a pediatric population.
Methods & Materials: We retrospectively searched the cardiac
MRI charts between August 2014 and September 2018 for
clinical indications of myocardial hyper trabeculation, LV non-
compaction, anomalous coronary origins, or Kawasaki disease.
The inclusion criteria was normal cardiac anatomy, as well as
normal preload and afterload. Epi and endocardial contours
(EC) were drawn on the end-diastolic short-axis bSSFP images
of the LV from mitral valve annulus to apex. These contours
were used for automatic extraction of the trabecular edges (T).
Following quantitative indices were computed using automated
tool: 1) NC/C length ratio (LR) perpendicular to EC at each
slice; 2) MR = percent NC of (NC+C) for entire LV; and 4)
perimetric ratio (PR = length of T / perimeter of EC) for each
slice. Global quantitative indices were derived as: 1) maximum
of LR (MLR) across all slices; 2) MR; and 4) CPR over all
slices. Combined criteria of MLR>2.3 and MR>35% was used
to define patients with prominent trabeculations.
Results: A total of 80 patients (14.3±5.0 yrs) met the inclusion
criteria. The values for MLR (1.99±0.88, 0.5-4), MR
(31.7±12.1, 13.2-55.6), and CPR (1.67±0.31, 1.20-2.41)
increased with degree of trabeculation as a continuous spectrum.
There is a significant correlation between MR and MLR with
correlation coefficient (r) of 0.85 (0.78-0.9). CPR has
significant correlation with both MLR (0.73, 0.61-0.82) and MR
(0.82, 0.73-0.88). Cut off value of CPR=1.6 yields 94% of area
under the receiver operating characteristics curve with 86%
sensitivity and 89% specificity.
Conclusions: CPR derived from epi and endocardial contours
typically drawn for LV functional analysis correlated strongly
with morphometric measures of NC/C length and mass ratios.
CPR provides comprehensive measure of irregularity and extent
of the LV trabeculations overcoming the inherent morphologic
variability from base to apex by providing comprehensive
measure of irregularity. CPR has potential to serve as a valuable
marker for prominent trabeculations when used along with LR
and MR.
Paper #: 118
Circumventing Anesthesia in Pediatric Cardiac Patients
Considered High-Risk for Anesthesia using Free Breathing
CMR
Amol Pednekar, PhD, [email protected]; Premal
Trivedi, Siddharth P. Jadhav, MD, Cory Noel, MD, Prakash M.
Masand, MD; Radiology, Texas Children's Hospital, Houston,
TX
Disclosures: Prakash Masand, MD: Consultant, Honoraria:
Canon Medical Systems, Phillips MRI Users Meeting 2018, Daiichi Sankyo, Speakers Bureau: Canon Medical Systems,
Royalty: Amirsys. All other authors have disclosed no financial
interests, arrangements or affiliations in the context of this
activity.
Purpose or Case Report: General anesthesia (GA), while not
always required, is frequently necessary in infants and children
undergoing cardiac magnetic resonance imaging (CMR) based
on risk-benefit of GA and breath-hold (BH) v/s the diagnostic
value of the acquired cine images. Primarily, requirement of BH
for cine imaging to evaluate ventricular volumes and function, a
key prognostic measure in spectrum of congenital heart
diseases, governs the necessity of GA. Herein we review our
experience of completely free breathing (FB) CMR, including
CArdio-REspiratory Synchronized (CARESync) cine imaging
instead of multiple signal averaging (MSA) cine imaging, in
unsedated pediatric population.
Methods & Materials: We retrospectively reviewed the
anesthesia and MRI records for all patients who had undergone
CMR between June 2017 and September 2018.
Results: Out of 1100 (17.1±7.8, 7.6-65.9 yrs) CMR studies
performed a total of 77 (14.5±8.7, 7.6-63.0 yrs) unsedated
patients were unable to hold their breath. All these 77 CMR
studies were completed without anesthesia using FB-CMR and
provided diagnostic image quality. Out of these 77 patients, 49
(14.9±12.5, 7.9-63.0 yrs) patients were considered high-risk
(HR) for anesthesia: single ventricles (6: 11.1±1.3, 8.7-12.3
yrs), hypertrophic cardiomyopathy (HCM) (14: 14.0±5.9, 8.2-
30.4 yrs), cardiomyopathy with moderate-to-severely depressed
function (4: 20.6±9.6, 11.6-33.2 yrs), myocarditis (7: 14.7±3.5,
9.0 – 18.4 yrs), and atrioventricular valve diseases including,
moderate-to-severe aortic insufficiency, aortic regurgitation, or
mitral stenosis (18: 14.1±5.1, 7.6 – 24.2 yrs). Three (13.5±3.0,
10.3 – 16.1yrs) patients were indicated for left ventricular non-
compaction (LVNC).
Conclusions: Our experience demonstrates that complete FB-
CMR studies including (CARESync) cine imaging allow
elimination of anesthesia while providing diagnostic
morphologic, functional and pathophysiologic evaluation in
young children, and adolescents considered high-risk for
anesthesia. CARESync has been previously reported to improve
image quality significantly over MSA and provide comparable
ventricular volumes [1]. Furthermore, superior delineation of
trabeculation and myocardium from blood pool allows accurate
measurements of non-compacted and compacted myocardium
critical for HCM and LVNC and overall better wall motion
assessment. It may be worthwhile to explore increased
utilization of FB-CMR to further reduce need for anesthesia.[1]
Krishnamurthy R et al. J Cardiovasc Magn Reson. 2015;17.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S120
Paper #: 119
Non-contrast Flow-independent Relaxation-Enhanced MR
Angiography Using Inversion Recovery and T2-Prepared
3D mDIXON Gradient-Echo DIXON Technique:
Applications in the Pediatric Population
Skorn Ponrartana, MD, MPH1, [email protected];
Michael Chiang, M.D.1, Quin Lu2; 1Radiology, Children's
Hospital Los Angeles, Los Angeles, CA, 2Philips Healthcare,
Cleveland, OH
Disclosures: Quin Lu, PhD: Salary: Philips. All other authors
have disclosed no financial interests, arrangements or
affiliations in the context of this activity.
Purpose or Case Report: While Gadolinium-based contrast-
enhanced MR Angiography (Gd-MRA) is a robust technique for
evaluation of the vascular system, there are inherent limitations,
such as the contraindication in renal failure and concern of
intracranial Gadolinium deposition. This study exams the
feasibility of flow-independent relaxation-enhanced MR
Angiography without contrast and triggering (REACT) in
various clinical indications and compares the sequence to
corresponding Gd-MRA.
Methods & Materials: The REACT sequence is a combination
of a two-point 3D chemical-shift water-fat separated mDIXON
TFE pulse sequence, a non-volume selective adiabatic inversion
pulse, and a four-refocusing-adiabatic-pulse T2-prep module,
which suppresses signal from static tissues and enhances the
long T1 and T2 native signal of unenhanced blood, thereby
providing optimal vessel-to-background signal contrast.We
retrospectively reviewed all cases where both the REACT
sequence and Gd-MRA were available for comparison between
June 2018 and October 2018. Imaging was performed on a 3
Tesla platform (Philips Ingenia, software R5.3) or a 1.5 Tesla
platform (Philips Achieva, software R5.3). Two pediatric body
radiologists in consensus qualitatively compared results from
REACT with Gd-MRA to evaluate whether it was
diagnostically useful either as a complement or potential
replacement.
Results: We retrospectively reviewed a total 5 cases with both
the REACT sequence and Gd-MRA. The clinical indications
included pre-operative evaluation for vascular access, thoracic
outlet syndrome, May-Thurner syndrome, deep venous
thrombosis, and complex venolymphatic malformation. The
REACT sequence was found to be equivalent at obtaining the
diagnosis in all 5 cases. However, in 4 of the 5 cases, Gd-MRA
provided improved contrast resolution and signal-to-noise
compared with the REACT sequence. Only in the case of
thoracic outlet syndrome were the images found to be non-
inferior.
Conclusions: Our preliminary experience with REACT in
children suggests that the sequence is robust and capable of
providing diagnostic angiograms in a variety of clinical
indications. One advantage of REACT is that it can be repeated
as needed and is not constrained by timing of a contrast bolus.
However, the major disadvantage of REACT is its lower
contrast resolution and signal-to-noise ratio compared with Gd-
MRA. Future studies with larger and more diverse sample sizes
are needed to better validate whether REACT can obviate the
need for Gd-MRA in more generalizable circumstances.
Paper #: 120
Image Quality Assessment of Cardiothoracic Respiratory
Motion Compensated Relaxation Enhanced 3D Non-
Contrast MRA with Reference to Dynamic Contrast-
Enhanced 3D MRA: A Pilot Study
Eric Diaz, MD, [email protected]; Siddharth P. Jadhav,
MD, Pamela Ketwaroo, Amol Pednekar, PhD, Wei Zhang,
Prakash M. Masand, MD; Texas Children's Hospital, Houston,
TX
Disclosures: Prakash M. Masand, MD: Consultant,
Honoraria: Canon Medical Systems, Phillips MRI Users
Meeting 2018, Daiichi Sankyo, Speakers Bureau: Canon
Medical Systems, Royalty: Amirsys. All other authors have
disclosed no financial interests, arrangements or affiliations in
the context of this activity.
Purpose or Case Report: This is a pilot study to evaluate
image quality of relaxation-enhanced, non-contrast, MR
angiography (RENC-MRA) in cardiothoracic vessels of
children as compared to standard, contrast enhanced dynamic
MRA (CE-dMRA). If RENC-MRA has similar or superior
diagnostic quality to CE-dMRA, the costs, and potential risks of
gadolinium (Gd) based contrast administration may be avoided.
Methods & Materials: A retrospective, cross-sectional study
was performed on consecutive patients undergoing clinically
indicated CE-dMRA on 1.5T clinical scanner (Ingenia, Philips)
between Aug 1, 2018 and Sep 31, 2018. Prior to administration
of Gd contrast, RENC-MRA was acquired with equivalent
spatial resolution and coverage as CE-dMRA. Informed consent
was waived.Patient age, sex, diagnosis, and multiple image
quality metrics were recorded for 8 vessels in RENC-MRA and
best phase CE-dMRA. Image quality was subjectively
compared using a visual Likert scale from 1 to 5 for vascular
edge clarity (EC). Quantitative metrics were computed based on
vessel and background tissue ROI measures and included: 1)
coefficient of variation (CV), 2) relative contrast (RC), and 3)
signal to noise and contrast to noise ratios (SNR, CNR).
Wilcoxon signed-rank test with alpha of 0.001, adjusted for
multiple comparison, was performed for both averaged
individual and average of all vessel metrics to assess for
statistical significance.
Results: Fifteen patients met inclusion criteria (Ages:2-21,
Male:10, Female:5). There was significantly lower vessel CV
for averaged and all individual vessels in RENC-MRA
(p<0.001), except in MPA and IVC (p=0.05), and SVC
(p=0.01). There was no significant difference in EC, RC,
background CV, SNR, and CNR for averaged vessel metrics.
There was significantly increased RC, SNR, and CNR in IVC
for RENC-MRA (p<0.001). There was a trend toward
significance with lower RC in MPA and LPA for RENC-MRA
(p=0.005), lower SNR and CNR in descending aorta for RENC-
MRA (p=0.01), and higher RC, SNR, and CNR in SVC for
RENC-MRA (p=0.01).
Conclusions: RENC-MRA sequence demonstrated similar
image quality metrics to CE-dMRA with some exceptions.
Although RENC-MRA cannot provide dynamic information,
our data suggests that RENC-MRA has greater uniformity of
image quality and superior characterization of systemic veins.
Diagnostic accuracy of RENC-MRA must now be evaluated
against post contrast equilibrium MRA, as similar accuracy of
these would provide useful options, especially for patients in
whom Gd-based contrast is contraindicated.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S121
Paper #: 121
Highly accelerated cardiorenal 4D flow MRI using 3D cones
trajectory
Christopher Sandino, M.S., [email protected]; Joseph Y.
Cheng, PhD, Marcus Alley, Shreyas Vasanawala, MD/PhD;
Electrical Engineering, Stanford University, Menlo Park, CA
Disclosures: Christopher Sandino, M.S.: Financial Interest:
General Electric Healthcare - Salary: Independent Contractor;
Marcus Alley, PhD: Consultant, Honoraria: Arterys, Research
Grant: GE Medical Systems. Joseph Y. Cheng, PhD:
Consultant, Honoraria: HeartVista, Inc., Research Grant: GE
Healthcare. Shreyas Vasanawala, MD/PhD: Arterys, Royalty:
Arterys, GE Healthcare, Siemens, Philips, Research Grants: GE
Healthcare. All other authors have disclosed no financial
interests, arrangements or affiliations in the context of this
activity.
Purpose or Case Report: Time-resolved, 3D phase-contrast
(4D flow) MRI enables comprehensive cardiac evaluation, but
long acquisition times and motion corruption limit pediatric
abdominal clinical use. Here, we develop and integrate a time-
efficient non-Cartesian 3D cones trajectory into 4D flow to
reduce scan time while also increasing robustness to respiratory
and bowel motion artifacts. We then assess whether the
resulting non-Cartesian 4D flow is able to achieve high-quality,
full-coverage cardiorenal evaluation in under 10 minutes.
Methods & Materials: We design a flow-encoded, golden-
angle re-ordered 3D cones pulse sequence based on RF-spoiled
gradient recalled echo (SPGR). Cones gradient waveforms are
iteratively designed on-the-fly to enable arbitrary field of view
and resolution prescription. Cardiac-resolved images are
reconstructed using a combined parallel imaging and
compressed sensing algorithm (l1-ESPIRiT). To further improve
motion-robustness, respiratory signals are estimated from each
cone readout, and then used to suppress motion during
reconstruction.With informed consent and IRB approval, 2
pediatric subjects (3-years-old and 7-years-old) referred for
contrast-enhanced abdominal MRI were scanned using
Cartesian 4D flow and cones 4D flow sequences on a 3T
scanner (MR750, GE Healthcare) with a 32-channel cardiac
coil. Cartesian and cones 4D flow scan parameters include
spatial resolution: 1.0x1.0x1.5 mm3, 8 cardiac phases, Venc:
100-150 cm/s, and scan durations: 5-7 minutes. All data was
acquired with subjects freely breathing.
Results: Cones 4D flow reconstructions are feasible and show
excellent delineation of renal vasculature in data acquired just
under 5 minutes. By nature of the cones sampling trajectory,
respiratory and bowel motion artifacts appear noise-like and
incoherent. Similar image quality is observed after
retrospectively undersampling data to simulate a 3-minute
acquisition. Further, both aortic and renal arterial flow rates are
conserved in the retrospectively undersampled acquisition. In a
7-minute acquisition, where the Cartesian and cones scan times
are held constant, cones 4D flow provides superior image
quality, but underestimates peak aortic flow by 26%. This
difference is attributed to larger eddy current errors in the cones
sequence, although, these can be corrected with more robust
physical models.
Conclusions: We introduce the first 4D flow sequence with a
3D cones sampling trajectory. Cones can highly accelerate 4D
flow acquisitions and reduce both flow and motion artifacts.
Paper #: 122
Multi Echo fLow-encoded Rosette (MELROSE) for
Quantitative Assessment of Cardiac and Intravascular T2*
and Blood Oxygen Saturation Determination
Adam Bush, Ph.D, [email protected]; Christopher
Sandino, M.S., Marcus Alley, Shreyas Vasanawala, MD/PhD;
Radiology, Stanford University, South San Francisco, CA
Disclosures: Christopher Sandino, M.S.: Financial Interest:
General Electric Healthcare - Salary: Independent Contractor;
Marcus Alley, PhD: Consultant, Honoraria: Arterys, Research
Grant: GE Medical Systems; Shreyas Vasanawala, MD/PhD:
Arterys, Royalty: Arterys, GE Healthcare, Siemens, Philips,
Research Grants: GE Healthcare. All other authors have
disclosed no financial interests, arrangements or affiliations in
the context of this activity.
Purpose or Case Report: Cardiac catheterization is an invasive
albeit common procedure performed in children with congenital
heart disease for intrathoracic oxygen saturation assessment that
exposes patients to anesthesia and risk of infection and
complication. Prior work with MRI based intrathoracic
oxygenation methods have failed due to partial voluming of the
blood pool and surrounding tissue. In this work we overcome
this challenge, by using subtractive, velocity encoding for
simultaneous flow, intravascular T2* and oxygen saturation
determination using a Multi Echo fLowencoded ROSEtte
(MELROSE) sequence. We validate flow and T2* values in a
flow phantom and present preliminary results in a healthy
subject.
Methods & Materials: TheoryRosette trajectories are flower-
like k-space traversal patterns first described by Doug Noll [1].
We use a novel parameterization that’s defines a rosette shape
parameter, q [2]. MethodsAll scans were performed on a GE
750W with a 20 channel cardiac array. A MELROSE sequence
with bipolar, tetrahedral, velocity encoding gradients of 100
cm/s, q= 2.2, FA = 15 and TR 34ms was constructed. A
ferumoxytol doped water, gravity feed flow phantom was
constructed. MELROSE assessment of flow and T2*
quantification was compared to gold standard, Cartesian phase
contrast for velocity measurements and gradient echo recalled
multiecho for T2*. In Vivo: A 28 y/o male volunteer was
imaged using a MELROSE sequence. All studies were IRB
approved and conducted with informed consent.
Results: The average velocity in the flow phantom measured
using Cartesian phase contrast was 45.3±12.6, 26.4±11.3 and
9.21 ±1.9 cm/s and 47.8±18.6, 27.7±12.0 and 8.48 ±2.6 cm/s
using MELROSE. The static GRE measured T2* of the doped
ferumoxytol solution was 21.9±1.0 ms and 18.6ms at an average
velocity of 27.7 cm/s and 19.4ms at an average velocity of 8.5
cm/s using MELROSE. T2* and flow images were
reconstructed in a volunteer subject.
Conclusions: DiscussionBoth quantitative flow and T2*
estimates were in excellent agreement using both gold standard
phase contrast and MELROSE in a constant flow phantom.
These phantom data and preliminary results in a healthy
volunteer demonstrate feasibility for time resolved blood flow
and T2* estimates in healthy subjects with applications for
noninvasive oxygenation assessment in children with congenital
heart disease.[1] Noll, IEEE Trans Med Imaging, 1997[2] Bush,
SPR 2019, Abstract #3110307
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S122
Paper #: 123
Contigious Rosette Echoes iN Single Highly Accelerated
Acquistion (CRENSHAA) for Motion Robust and Time
Resolved Cardiac and Abdominal T2* Assessment
Adam Bush, Ph.D1, [email protected]; Christopher
Sandino, M.S.1, Shreya Ramachandran2, David Zeng, MS1,
Joseph Y. Cheng, PhD1, Marcus Alley1, Shreyas Vasanawala,
MD/PhD1; 1Radiology, Stanford University, South San
Francisco, CA, 2California Institute of Technology, Pasadena,
CA
Disclosures: Christopher Sandino, M.S.: Financial Interest:
General Electric Healthcare - Salary: Independent Contractor;
David Y. Zeng: Financial Interest: GE Healthcare - Research
Funding: Research; Marcus Alley, PhD: Consultant,
Honoraria: Arterys, Research Grant: GE Medical Systems;
Joseph Y. Cheng, PhD: Consultant, Honoraria: HeartVista,
Inc., Research Grant: GE Healthcare; Shreyas Vasanawala,
MD/PhD: Arterys, Royalty: Arterys, GE Healthcare, Siemens,
Philips, Research Grants: GE Healthcare. All other authors have
disclosed no financial interests, arrangements or affiliations in
the context of this activity.
Purpose or Case Report: Multidimensional imaging
approaches reduce total examination time by using a single
acquisition to reconstruct several images contrast states,
typically requiring several independent scans. In children, this
scan reduction increases patient comfort and compliance while
reducing the need for anesthesia. In this work, we introduce a
novel multidimensional imaging approach that utilizes a rosette,
or flower-like, k-space trajectory entitled Contiguous Rosette
Echoes iN Single Highly Accelerated Acquisition
(CRENSHAA). Using CRENSHAA, we demonstrate feasibility
for self-gated, motion resolved T2* mapping for simultaneous
cine imaging and iron quantification.
Methods & Materials: TheoryRosette trajectories employ
oscillating gradient fields at two distinct frequencies to produce
flower-like k-space traversal patterns first described by Doug
Noll [1]. We extend this earlier work by using a novel rosette
parameterization: If N is odd, q = { x | x = (2L-1)/N, L =
(N+1+2m)/2, m Î Z+} \ Z+If N is even, q = { x | x = (2L)/N, L =
(N-2+4m)/2, m Î Z+} \ Z+ where N represents the number of
petals, L the number of layers, m is an incrementing variable
and Z+ is the set of all positive integers. MethodsAll scans were
performed on a GE 750W with a 20 channel cardiac array. Ex
Vivo: T2* phantoms containing distilled water, MnCl2 and 3%
carrageenan in 50ml falcon tubes were constructed for T2*
validation. A CRENSHAA sequence with q=2.2, FA= 15
degrees and TR 34 ms produced echoes at 1.1, 4.1, 6.7, 9.3 and
11.9ms. 350 repetitions were acquired, each successively
incremented by a rotation angle of 137.5° Exponential fitting
was performed in MATLAB. Images were compared to a gold
standard GRE multiecho sequence. In Vivo: A 31 y/o male
volunteer was imaged using a CRENSHAA sequence. Self-
gated, k-space magnitude CINE images were reconstructed at
30 phases with a 5 phase sliding window. All studies were IRB
approved and conducted with informed consent.
Results: The measured T2 values using the gold standard GRE
sequence were 70.4±8.3, 32.2±2.2, 28.5±2.0, 30.3±3.0,
7.8±0.51, 5.0±0.4 whereas the CRENSHAA measured T2*
values were 64.9±19.6, 33.0±5.7, 28.5±7.6, 27.3±5.2, 10.0±0.7
and 6.4±0.5. CINE and T2* map reconstructions were
performed in healthy volunteer subject.
Conclusions: CRENSHAA was successful in producing
comparable T2* values to the gold standard in phantoms and
reasonable values in a heathy subject. Future uses will explore
motion resolved cardiac and liver iron assessment in children.
Paper #: 124
Deep learning-based reconstruction of 2D cardiac CINE
MRI data
Christopher Sandino, M.S.1, [email protected]; Peng Lai,
Ph.D.2, Shreyas Vasanawala, MD/PhD1, Joseph Y. Cheng, PhD1 1Electrical Engineering, Stanford University, Menlo Park,
CA, 2General Electric Healthcare, Menlo Park, CA
Disclosures: Christopher Sandino, M.S.: Financial Interest:
GE Healthcare - Salary: Independent contractor; Shreyas
Vasanawala, MD/PhD: Arterys, Royalty: Arterys, GE
Healthcare, Siemens, Philips, Research Grants: GE Healthcare;
Joseph Y. Cheng, PhD: Consultant, Honoraria: HeartVista,
Inc., Research Grant: GE Healthcare; Peng Lai, PhD: Salary:
GE Healthcare. All other authors have disclosed no financial
interests, arrangements or affiliations in the context of this
activity.
Purpose or Case Report: Cardiac CINE is a common MRI
technique for cardiac evaluation, but requires multiple breath-
holds to acquire high quality images without respiratory motion
artifacts. This in conjunction with rapid heart rate makes
pediatric CINE imaging challenging. Neural networks can
leverage previous exam data to learn how to reconstruct highly
accelerated MRI data. Here we extend this to cardiac imaging,
and present a deep learning-based reconstruction technique
trained on fully-sampled healthy volunteer data. We show that
our network outperforms combined parallel imaging and
compressed sensing (PICS) reconstruction methods on 10x
accelerated 2D CINE data with respect to common image
quality metrics.
Methods & Materials: The proposed unrolled network
iteratively applies 3D convolutional neural networks and data
consistency updates to under-sampled input data. Data
consistency layers enforce consistency with input k-space
samples, and help the network generalize to data acquired from
unhealthy patients. The network is trained to output fully-
sampled complex images, preserving both magnitude and
phase.With IRB approval, fully sampled 2D bSSFP cardiac
CINE datasets were acquired from 12 healthy volunteers at
different cardiac views and slice locations on 1.5T and 3.0T GE
scanners. For training, ten volunteer datasets are split slice-by-
slice into 155 slices, and then further augmented by random
flipping, cropping, and variable-density undersampling (R=8-
10). For evaluation, the remaining two volunteer datasets are
retrospectively undersampled to simulate 10-fold acceleration
with 25% partial echo. The same evaluation datasets are
reconstructed using the proposed method and a PICS algorithm
(l1-ESPIRiT). Reconstruction quality is evaluated with respect
to peak signal-to-noise ratio (PSNR) and structural similarity
index (SSIM).
Results: The proposed method outperforms PICS with respect
to both PSNR and SSIM metrics. The improvement of the
proposed method over PICS is most apparent inside the heart
with less spatiotemporal blurring of myocardium and papillary
muscles in deep reconstructions. Deep reconstructions also
depict systolic heart motion much more naturally, whereas PICS
is susceptible to temporal staircasing artifacts due to strong
regularization.
Conclusions: Preliminary results suggest that the proposed
method can reconstruct 2D cardiac CINE data more accurately
and robustly than compressed sensing. This technique can
improve image quality for single breath-hold, and in the future,
free-breathing scans.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S123
Paper #: 125
The utility of the ASL sequence in parenchymal injury of
the brain in abusive head trauma (AHT).
Alex Chan, D.O.2, [email protected]; Arabinda
Choudhary, M.D.1, Rahul Nikam, M.D.1, Vinay V. Kandula,
M.D.1; 1Nemours/Alfred I. duPont Hospital for Children,
Wilmington, DE, 2Christiana Care Health System, Newark, DE
Disclosures: Arabinda Choudhary, M.D.: Consult, Honoraria:
Child Abuse Lectures, Equity Interest/Stock Options: GE
Shares. All other authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To determine whether the ASL
sequence can provide added value by demonstrating additional
parenchymal abnormalities that are not easily identifiable on
conventional MRI sequences.
Methods & Materials: In this IRB approved retrospective
study, we reviewed MRI brain cases performed in children
referred to child protective services at an US academic pediatric
hospital between 2012-2018. The analysis was performed by an
experienced Neuroradiologist and a senior Radiology Resident
which assessed individual brain MRI exam for parenchymal
changes identified on the ASL sequence and compared the
findings with the other routine MRI sequences of the same
exam. The ASL sequence was considered to provide added
value if the ASL findings revealed additional parenchymal
perfusion abnormalities not identified on routine sequences
(T2WI, T1WI, FLAIR, SWAN, and DWI/ADC map) and with
evidence of atrophy on either MRI or CT brain, if follow up
imaging was performed. ASL was considered to not provide
added value if the ASL findings did not reveal additional
parenchymal perfusion abnormality. We excluded patients in
which the imaging workup did not include an MRI study, ASL
sequence, or uninterpretable ASL acquisition.
Results: A total of 54 patients were surveyed with an average
age of 157.3 days. Of the 54 patients, 31/54 cases (57.4%) were
excluded based on the described criteria. Of the included
patients, 23/43 cases (42.6%), 9/23 cases (39.1%) demonstrated
that ASL added value and 14/23 cases (60.9%) demonstrated no
added value. Of the cases where ASL added value, 7/9 cases
(77.8%) showed the sequela of brain parenchymal atrophy on
follow up imaging within the previously identified areas of
perfusion abnormalities, while the remaining 2/9 cases (22.2%)
had no follow up imaging. Of the 9/23 cases where ASL
demonstrated added value, 5/9 cases (55.6%) were male and 4/9
cases (44.4%) were female. Of the 14/23 cases where ASL
demonstrated no added value, 9/14 (64.3%) cases were male
and 5/14 (35.7%) cases were female.
Conclusions: Our study demonstrated that in cases of suspected
abusive head trauma, evaluation of the ASL sequence in
addition to other MRI sequences provided additional
information regarding parenchymal injury as compared to
routine MRI sequences alone. We propose that by adding the
ASL sequence, in the setting of suspected AHT, to the
evaluation brain parenchymal injury would add value by
improving the detection of injury, assess long term prognosis,
and may also help understand the mechanism of injury.
Paper #: 126
ASL Perfusion Imaging of the Frontal Lobes Predicts the
Occurrence and Resolution of Posterior Fossa Syndrome
Maryam Maleki, M.D., [email protected]; Derek W.
Yecies, M.D., Katie Shpanskaya, Kristen W. Yeom, M.D.;
Stanford University School of Medicine, Stanford, CA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Posterior fossa syndrome (PFS) is a
common complication following the resection of posterior fossa
tumors in children. The pathophysiology of PFS remains
incompletely elucidated, however the wide-ranging symptoms
of PFS suggest the possibility of wide-spread cortical
dysfunction. In this study, we utilize arterial spin labeling
(ASL), an MR perfusion imaging modality that provides
quantitative measurements of cerebral blood flow without the
use of intravenous contrast, to assess cortical blood flow in
patients with PFS.
Methods & Materials: A retrospective review of pediatric
medulloblastoma patients who underwent surgical tumor
resection between 2004 and 2016 at our institution was
performed. Postoperative ASL imaging was available for 14
patients who developed PFS and 10 age-matched controls.
Bilateral frontal lobe perfusion measured was compared
between PFS and control patients immediately after surgery.
Additionally, in patients with PFS, ASL following the return of
speech was compared with immediate postoperative ASL.
Results: On immediate postoperative ASL, patients who
subsequently developed PFS had decreased right frontal lobe
perfusion (37.00 ± 13.46 vs 49.7 ± 13.72, p=0.046) and a trend
towards decreased perfusion in the left frontal lobe (41.00 ±
17.36 vs 53.5 ± 14.62, p = 0.092) compared to age-matched
children who did not develop PFS after tumor resection.
Patients with PFS had statistically significant increases in right
(55.79 ± 18.34 vs 40.71 ± 15.27, p=0.018) and left 60.79 ±
21.75 vs 44.07 ± 17.25, p =0.028) frontal lobe perfusion after
the resolution of symptoms compared to their immediate
postoperative imaging.
Conclusions: ASL perfusion imaging identifies decreased
frontal lobe blood flow as a strong physiologic correlate of PFS
that is consistent with the symptomatology of PFS. This is also
the first study to demonstrate that decreases in frontal lobe
perfusion are present in the immediate postoperative period and
resolve with the resolution of symptoms, suggesting a
physiologic explanation for the transient symptoms of PFS.
Paper #: 127
Neuroimaging findings in infants with human parechovirus
infection
Asha Sarma2, [email protected]; Emily Hanzlik2, Rekha
Krishnasarma1, Lindsay Pagano2, Sumit Pruthi2; 1Boston
Children's Hospital, Boston, MA, 2Vanderbilt University
Medical Center, Nashville, TN
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To evaluate neuroimaging findings in
patients with human parechovirus (HPeV) infection and review
the current literature.
Methods & Materials: This retrospective review includes 6
cases from 2 children's hospitals. The electronic medical record
was reviewed for parameters including patient age and sex, birth
history and gestational age at birth, presenting symptoms, length
of hospital/ICU stay, white blood cell count, cerebrospinal fluid
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S124
(CSF) analysis, and electroencephalography (EEG) results.
MRI, US, and CT (if available) findings were assessed by two
attending pediatric neuroradiologists. Technique and sequences
acquired varied by case and institution.
Results: 6 infants presented at <60 days of life (DOL) with
irritability, decreased PO intake and/or multifocal seizures. 4
full-term infants presented in the first 10 DOL, and 2 premature
infants (33 and 35 weeks gestational age) presented on DOL 20
and 35. CSF showed no pleocytosis and was culture negative
but was positive for HPeV by polymerase chain reaction-based
testing. In 6/6, DWI demonstrated low ADC in the
frontoparietal and temporal white matter, corpus callosum,
internal and external capsules, optic radiations, frontal and atrial
periventricular white matter, and thalami. 5/6 studies
demonstrated low ADC in the occipital white matter and 2/6
cases demonstrated low ADC in occipital cortex. In 2/6 cases
(from a single institution), T1-weighted imaging demonstrated
hyperintensity in the corona radiata. Mild T2 prolongation was
noted in involved white matter, and in 3/6 cases from a single
institution, T2 shortening was observed along the distribution of
deep medullary veins. 1/3 studies with MRS showed elevated
lactate.
Conclusions: Brain MRI in HPeV infection tends to show a
characteristic pattern of low diffusivity involving major
supratentorial white matter tracts including the corpus callosum,
and the thalami. Cortical involvement is unusual and the basal
ganglia, brainstem, and cerebellum are spared. T2 shortening
along the distribution of deep medullary veins in 3/6 cases
(from a single institution obtained with similar MRI acquisition
parameters) suggests perivenular invasion with venous ischemia
as a potential etiology. This hypothesis is supported by
histopathologic analysis provided by a case from the literature,
which demonstrated the presence of HPeV in blood vessel
walls.
Paper #: 128
Longitudinal Brain MRI Characterization of Normal
Appearing Zika-exposed children using advanced MRI
techniques and Correlations with Neurodevelopmental
Outcomes
Jessica Riotti, MD1, [email protected]; Shanchita
Ghosh2, Amrutha Ramachandran1, Fiama Reyes Avila1, Ivan
Gonzalez1, Varan Govind1, Gaurav Saigal1; 1University of
Miami, Miami, CA, 2UC Davis, Sacramento, CA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Congenital Zika syndrome (CZS) is
unique to fetuses infected with Zika virus (ZIKV) before birth
and presents with distinct pattern of birth defects including
characteristic brain abnormalities. The neurological
manifestations in these infants with CZS have emerged lately
and are well documented. However, the consequences of ZIKV
exposure to fetuses of pregnant mothers and the neonates born
to them were not thoroughly examined. Despite these ZIKV-
exposed neonates demonstrating normal head circumference at
birth [1], they may have subtle brain abnormalities and
neurodevelopmental deficits that are possibly associated with
congenital ZIKV [2,3]. Since these ZIKV-exposed infants
represent a larger population as compared to those with CZS, it
becomes all the more important to examine the brains of this
group. The purpose of this prospective study is to compare the
brain MRI volume measures of otherwise normal appearing
ZIKV-exposed infants to matched controls, with
neurodevelopmental correlates.
Methods & Materials: Volumetric MRI data of ZIKV-exposed
infants (n = 9) and normal controls (n = 5), acquired from 1 to
6-months gestational age were scanned without sedation or
contrast on a 3T MRI scanner. The MR protocol consists of T2,
diffusion kurtosis imaging (DKI), susceptibility weighted
imaging, and MR Spectroscopy (MRS) sequences. The images
were hand contoured using Multitracer software to quantify the
brain parenchymal and CSF volumes. The volumteric data of
the above groups was compared, and the volume data of the
ZIKV exposed group was correlated with outcomes of the
NICU Network Neurobehavioral Scale administered at full-term
equivalent gestation and the Bayley-III assessment performed at
6 months of age using the Student’s T-test and Pearson’s
correlation test.
Results: The findings in the ZIKV-exposed neonates include a)
significantly decreased brain parenchymal and supratentorial
volumes and increased CSF volume as compared to matched
controls, and b) a positive association between brain
parenchymal volume and Bayley-III Language and Cognitive
Composite Scores.
Conclusions: Our preliminary results demonstrate some of the
neonates exposed to ZIKV show Zika-associated brain and
neurobehavioral abnormalities. Further evaluation of the DKI
and MRS sequences will allow for additional conclusions
regarding subtle changes in tissue microstructure and metabolic
activity, respectively. Longitudinal collection of brain imaging
and behavioral data will further refine the clinical impact of
Zika disease.
Paper #: 129
Brain Network Architecture Correlates with Seizure-Free
Outcome in Children Undergoing Epilepsy Surgery
Zili D. Chu, PhD, [email protected]; Wei Zhang,
Michael Paldino, MD; Texas Children's Hospital, Houston, TX
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Surgery is an important option in the
management of medically refractory epilepsy. Yet even in ideal
surgical cohorts, a significant fraction of patients (typically 35-
45%) do not achieve seizure freedom. This failure reflects in
large part that pediatric focal epilepsy is a disorder of
widespread cerebral cortical networks; some of these network
alterations are epileptogenic and can drive recurrent seizures
after resection. The goal of this study, therefore, was to define
the relationship between global network architecture and
seizure-free outcome in children selected for surgical
management of focal epilepsy.
Methods & Materials: This is a retrospective, IRB approved
study. Patients were identified who underwent surgical resection
for seizure management and had 3Tesla-MR before surgery,
including rs-fMRI. Surgical outcomes were assessed using the
Engel classification: 1. free of disabling seizures; 2. rare
disabling seizures; 3. some improvement; 4. no improvement.
Resting state fMRI images were co-registered to a T1-weighted
structural image, corrected for motion, and high-pass filtered
(0.01 Hz). Networks for each child were defined using an
anatomic parcellation technique with subdivision of whole brain
gray matter into approximately 750 nodes. An undirected graph
was constructed based on the pair-wise correlation of node
BOLD time series. The following topological properties were
calculated: clustering coefficient, modularity, path length and
efficiency. A multivariate statistical learning technique was
used to measure the independent contribution of each metric
(adjusting for age, sedation during MR, gender, seizure duration
and pathologic diagnosis) to surgical outcome.
Results: Fifty-two patients met inclusion criteria (21 female,
mean age 10.3 ± 5.42 years). Diagnoses included primarily
focal cortical dysplasia (n=21) and mesial temporal sclerosis
(n=15). Global efficiency, clustering coefficient, and pathologic
diagnosis each made an independent contribution to prediction
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S125
of Engel outcome by the learning algorithm. Prediction of Engel
class 1 outcome was driven by global efficiency; Engel class 4
prediction by clustering coefficient.
Conclusions: We observed characteristic global network
signatures of good/poor outcomes after epilepsy surgery. These
findings support the potential clinical relevance of brain
network metrics in children with refractory epilepsy.
Paper #: 130
Using Connectome Mapping to Define a Target for Deep
Brain Stimulation in Paediatric Dystonia
Ailish Coblentz1, [email protected]; Alexandre
Boutet2, Musleh Algarni2, Gavin Elias2, Lais Oliveira2, Elysa
Widjaja1, George Ibrahim1, Alfonso Fasano2, Andres Lozano2; 1The Hospital for Sick Children, Toronto, Ontario, Canada, 2Toronto Western Hospital, Toronto, Ontario, Canada
Disclosures: Alfonso Fasano: Consultant, Honoraria: Abbvie,
Boston Scientific, Medtronic, Royalty: Springer, Research
Grants: Abbvie, Boston Scientific, Medtronic; Andres Lozano:
Consultant, Honoraria:Medtronic, St. Jude, and Boston
Scientific. All other authors have disclosed no financial
interests, arrangements or affiliations in the context of this
activity.
Purpose or Case Report: Dystonia is one of the most common
paediatric movement disorders, and often the most difficult to
manage. Deep brain stimulation (DBS) is a surgical treatment
that modulates dysregulated motor circuits, and has been used in
321 medically refractory cases, with mixed outcomes. Factors
preventing maximal benefit may include: heterogeneous disease
aetiologies, suboptimal lead placement, and difficulty in
programming. Surgical insertion currently relies on adult-
derived techniques and anatomic targeting. During
programming, the clinician chooses which electrical settings,
e.g. voltage, provide the greatest clinical benefit to an individual
patient. Choosing these individualised parameters can be a
tedious and often imprecise trial-and-error process. It requires
multiple clinic visits, and reliance on difficult clinical
observations. With appropriate targeting and stimulation
programming, DBS can produce striking clinical benefits. We
hypothesized that the imaging of our DBS-implanted paediatric
dystonia patients could inform us on which neural networks and
tracts should be modulated, resulting in improved clinical
outcomes.
Methods & Materials: We conducted a retrospective analysis
of 11 paediatric dystonia patients who underwent Globus
Pallidus internus (GPi) DBS insertion at our institution. DBS
electrodes were localized and transformed into a normative
brain space. Volume of tissue activated (VTA) was estimated
and weighted according to their associated clinical outcomes.
Normative data were then used to identify functional and
structural networks associated with optimal clinical benefits.
Results: The majority of our patients demonstrated clinical
improvement. Using standardized neurosurgical coordinates, the
optimal area of stimulation was located at 22, -8, -2, within the
posterior GPi. This anatomical locale resulted in the best
clinical benefit and lowest side effect profile, as determined
clinically. The most closely associated neural network areas
were the bilateral basal ganglia, cerebellum, and prefrontal
cortex, all of known importance in motor circuitry. White matter
tracts associated with the greatest clinical improvement were
also involved in motor circuitry.
Conclusions: Paediatric dystonia patients responded better to
DBS treatment engaging specific networks and tracts of the
motor circuit. These findings could be used to improve surgical
technique and post-operative empiric electrical titration, thereby
benefiting patients and their families through better care and
clinical outcomes.
Paper #: 131
In the era of mTOR inhibitors for treatment of tuberous
sclerosis complex, is MRI surveillance of subependymal
giant cell atrocytoma growth reliable without gadolinium?
Ezekiel Maloney, MD, [email protected]; A. Luana Stanescu,
MD, Francisco Perez, MD, Ramesh Iyer, MD, Stephanie
Randle, MD, Randolph K. Otto, MD, Dennis W. Shaw, MD;
Radiology, Seattle Children's Hospital, Seattle, WA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Subependymal giant cell
astrocytomas (SEGAs) are low grade tumors, typically found in
patients with tuberous sclerosis complex (TSC). SEGAs have
slow growth potential and can cause ventricular obstruction.
Key characteristics to support SEGA diagnosis are: 1)
enlargement on serial MRIs and 2) hydrocephalus caused by a
subependymal lesion. TSC patients often undergo annual MRI
of the brain with gadolinium based contrast media (GBCM)
until 25 years old. If a SEGA is identified, therapies include
surgery or mTOR inhibitors (mTORi). Response to mTORi’s is
variable, and determined by changes in tumor volume on MRI.
Life-long mTORi therapy with extended imaging monitoring
may be required to maintain therapeutic benefit. In the setting of
increasing concerns regarding gadolinium retention in the body,
we aimed to preliminarily assess utilization of non-GBCM-
enhanced MRI sequences for identification of clinically
meaningful changes in SEGA volume.
Methods & Materials: Following IRB approval, the medical
records and imaging for an internal database of TSC patients
seen at our tertiary pediatric referral center in the last 2 years
were reviewed. Patients with SEGAs demonstrating “clinically
meaningful growth” (resulting in SEGA diagnosis or offer of
tumor directed intervention) on serial MRI exams were
identified. Paired exams were reviewed by a subspecialty board
certified pediatric neuroradiologist to determine changes in
tumor volume first on non-GBCM-enhanced sequences (T2W,
T1W), and subsequently on GBCM-enhanced T1W sequences.
Wilcoxon rank sum tests were performed in R.
Results: Of 68 patients in the TSC database, 9 (13%) had
SEGAs. 6 of these patients had 7 SEGAs that demonstrated
clinically meaningful growth on serial MRI exams. For these
exam pairs, the distribution in measured changes in tumor
volume was not significantly different when assessed with non-
GBCM-enhanced sequences versus GBCM-enhanced sequences
(p= 0.96), or between non-GBCM-enhanced sequence
assessments (p= 0.88). Changes in tumor volume ranged from
148% to 115,050% increase.
Conclusions: TSC patients often undergo a large number of
GBCM-enhanced MRI exams. In our study, assessments of
changes in SEGA volume on MRI were not significantly
different between GBCM-enhanced and non-GBCM-enhanced
sequences. Given the lack of clinical benefit, it is prudent to
limit GBCM administration for routine MRI follow up of
subependymal nodules and known SEGAs in patients with TSC.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S126
Paper #: 132
Non-inferiority of a non-gadolinium-enhanced MRI follow
up protocol for isolated optic pathway gliomas – interim
analysis from a multi-reader-multi-case study
Ezekiel Maloney, MD1, [email protected]; A. Luana Stanescu,
MD1, Francisco Perez, MD1, Ramesh Iyer, MD1, Randolph K.
Otto, MD1, Jason Wright, MD1, Sarah Menashe, MD1, Daniel
Hippe, MS2, Dennis W. Shaw, MD1; 1Radiology, Seattle
Children's Hospital, Seattle, WA, 2University of Washington,
Seattle, WA
Disclosures: Daniel Hippe: Research Grants: GE, Philips,
Siemens, Toshiba. All other authors have disclosed no financial
interests, arrangements or affiliations in the context of this
activity.
Purpose or Case Report: Pediatric patients with optic pathway
gliomas (OPGs) undergo a large number of follow-up MRI
brain exams with gadolinium based contrast media (GBCM).
Gadolinium retention in children has motivated parsimonious
use of GBCM. We previously determined that increased OPG
size was the only isolated finding on MRI that motivated
changes in tumor directed therapies. In a pilot case series,
change in tumor size was readily identifiable on non-GBCM
enhanced MRI sequences. Our purpose was to investigate this
result in a blinded, non-inferiority, multi-reader-multi-case
study.
Methods & Materials: Following IRB approval, power
calculations were performed with pilot data. The primary
endpoint was intra-reader agreement for ≥25% increase in
greatest axial diameter cross-product measurement. A
denominator OPG population was derived from a regional
cancer registry at our tertiary pediatric referral center.
Consensus tumor board notes were reviewed for each patient,
with attention to: (1) isolated OPG status, (2) change or (3)
stability in OPG size between two specific MRI exams. All
instances of criteria 1 & 2 were incorporated in the case set.
Cases meeting criteria 1 & 3 were incorporated in order of most
recent clinical follow up, maintaining a 50% ratio of NF1:non-
NF1 exams. Exams were standardized with non-GBCM-
enhanced and GBCM-enhanced versions. 7 pediatric
radiologists were assigned to a randomized case panel for 3
blinded sessions, spaced by at least 1 week. The first session
excluded GBCM-enhanced sequences, the others did not.
Interim statistical analysis was performed in R for 4 readers.
Results: Power calculations revealed that a ≥80% probability of
rejecting, at the α= 0.05 level, the null hypothesis of -12% (non-
inferiority margin) difference in intra-reader assessments
beyond background variability could be achieved with an “n” of
60 exam pairs, each interpreted by at least 4 readers. Exam pairs
were compiled from 42 patients with isolated OPG (19 with
NF1), from a population of 104 patients with OPG. There were
8 “size change” exam pairs from 7 NF1 patients and 20 “size
change” pairs from 18 non-NF1 patients. Tumors encompassed
a diverse anatomic spectrum. Interim analysis demonstrated an
overall -3% difference (95% CI: -9.9, 3.1%) in intra-reader
agreement when using a non-GBCM-enhanced protocol.
Conclusions: Interim analysis suggests that a non-GBCM-
enhanced protocol is non-inferior to a GBCM-enhanced
protocol for assessment of change in size of isolated OPGs on
follow-up MRI exams.
Paper #: 133
Primary intracranial sarcoma in pediatrics: MRI findings
Carlos Ugas Charcape, Radiologist1 ,[email protected]
Claudia I. Lazarte, MD2, Osmar A. Pillaca3, Waldemar
Mamani4, Nella P. Baca5; 1Cleveland Clinic Abu Dhabi, Abu
Dhabi, United Arab Emirates; 2 Instituto del Nino San Borja; 3
Clinica Internacional San Borja 4; Hospital Nacional Daniel
Alcides Carrion; Hospital II Luis Negreiros5
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Background: Primary brain
sarcomas are rare, with an incidence reported ranging from 0.1
to 4.3% of all cerebral tumors and with a high mortality. There
is a paucity of literature depicting radiologic features in
children. Objective: Describe the most frequent MRI findings of
pediatric intracranial sarcomas.
Methods & Materials: We retrospectively analyzed the data of
12 consecutive pediatric patients (7 boys and 5 girls; mean age:
8 years) referred to two national paediatric centres who
underwent MRI imaging within a 48-month period.
Results: The most frequent MR feature were the presence of
hemorraghe and necrosis, both in 92% (n=11); diffusion
restriction and presence of cystic component, both in 83% (n=
10); regular borders and homogenous intense enhancement, in
75% (n= 9) ; and finally 67% (n=8) of tumors were
supratentorial and showed extension to the meninges. Perfusion
was performed in 7 patients, all of them with increased
perfusion. 8 patients had spectroscopy, 50% (n= 4) of this cases
showed increased lactate, lipids and choline and decreased
NAA.
Conclusions: In the setting of pediatric brain tumor with regular
edges, diffusion restriction, hemorrhage, cystic component,
homogenous intense enhancement and increased perfusion, we
must consider primary intracranial sarcoma in the differential
diagnosis.In the setting of pediatric brain tumor with regular
edges, diffusion restriction, hemorrhage, cystic component,
homogenous intense enhancement and increased perfusion, we
must consider primary intracranial sarcoma in the differential
diagnosis.
Paper #: 134
Thalamic lesion in Leigh syndrome: An unusual finding
mimicking Percheron artery infarct
Sara R. Teixeira, [email protected]; Cesar Augusto
Alves, M.D, Fabricio G. Goncalves, Karuna Shekdar, MD, Juan
S. Martin-Saavedra, MD, Colleen Muraresku, Amy Goldstein,
Giulio Zuccoli, Children’s Hospital of Philadelphia,
Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Leigh syndrome (LS) (subacute
necrotizing encephalopathy) is a rare mitochondrial cytopathy
(MC) that commonly evolve in severe neurological impairment
and death in childhood. LS is caused by different genetic
mutations and, therefore, may yield variable imaging patterns.
Classic imaging findings of LS are abnormal signal intensity of
the basal ganglia and brainstem. However, unusual imaging
findings can also be seen but have been rarely described in the
literature. The purpose of this study is to describe the prevalence
and the pattern of unusual lesions involving the thalami in
patients with LS.
Methods & Materials: This is a retrospective study approved
by the Institutional Review Board (IRB). Over a 19-year period
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S127
(2000-2018), a search for MC in the clinical and radiological
database of a single academic children’s hospital was
performed. Inclusion criteria were: confirmed genetic mutation
related to MC, available brain magnetic resonance imaging
(MRI), and final diagnosis of LS. Diagnosis of LS was an
according to the previous clinical described criteria retrieved
from the medical notes. MRIs were reviewed on a standardized
fashion by experienced pediatric neuroradiologists. Statistical
analysis was performed accordingly.
Results: Out of 105 patients with confirmed genetic mutation of
MC and available brain MRI, 34 met our inclusion criteria with
a diagnosis of LS. Fifteen percent (N = 5) of the patients had
bilateral thalamic lesions. Of these, 60 % (N = 3) had a stroke-
like appearance similar to the Percheron artery infarction
(selective bilateral medial thalamic involvement). All of the
patients had oxidative phosphorylation deficiency involving the
Complex I proteins. Specifically, underlying mutations were
present in the genes NDUFS8, NDUFS4, ND3, and 2 patients
with mutation in the gene ND5. All 3 patients with an imaging
pattern mimicking the Percheron artery infarct had
mitochondrial DNA defects in the ND3 and N5 genes. In all of
the 5 patients, MRI showed at least one other lesion classically
described in LS (brainstem and/or basal ganglia abnormalities).
Conclusions: Thalamic lesions may be present in LS. Our
analysis demonstrated that lesions mimicking Percheron artery
infarction may be seen in LS. This pattern must be considered in
the differential diagnosis in the context of mitochondrial
disorders.
Paper #: 135
Introduction of Targeted Rapid Knee MRI exam using T2
Shuffling into Clinical Practice: Retrospective Analysis on
Image Quality, Cost and Scan Time
Jon Tamir, PhD2, [email protected]; Jesse Sandberg, M.D.1
Fidaa Wishah, MD1, Michael Lustig, PhD2, Marcus Alley3,
Shreyas Vasanawala, MD/PhD1; 1Radiology, Lucile Packard
Children's Hospital - Stanford University, Palo Alto,
CA, 2University of California, Berkeley, Berkeley, CA, 3Radiological Sciences Laboratory, Stanford University,
Stanford, CA
Disclosures: Jon Tamir, PhD: Consultant, Honoraria & Equity
Interest/Stock Option: Subtle Medical, Research Grants: GE
Healthcare; Marcus Alley, PhD: Consultant, Honoraria:
Arterys, Research Grant: GE Medical Systems; Shreyas
Vasanawala, MD/PhD: Arterys, Royalty:Arterys, GE
Healthcare, Siemens, Philips, Research Grants: GE Healthcare.
All other authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Volumetric fast spin echo (FSE) of
the knee using T2 shuffle (T2Sh) technique has previously been
described as being comparable to traditional 2D imaging. T2Sh
has the added advantage of being a rapid single-scan 4D
multiplane reformattable sequence for pediatric knee
examinations. The purpose of this study is to investigate the
feasibility and effectiveness of a targeted rapid pediatric knee
MRI exam after introduction into clinical practice, with the goal
of reducing cost and enabling same-day MRI access.
Methods & Materials: In an institutional review board
approved study with informed consent/assent, we implemented
a targeted pediatric knee MRI exam on three 3T scanners for
assessing pediatric knee pain. The 10-minute protocol was
based on T2 Shuffling, a four-dimensional acquisition that
permits volumetric reconstruction of images with variable T2
contrast, and a single T1 2D FSE sequence. To enable a
clinically feasible image reconstruction time, a distributed,
compressed sensing-based iterative reconstruction was
implemented on a local four-node high-performance compute
cluster and integrated into the clinical scanner and PACS
workflow. Pediatric patients were sub-selected for the exam
based on insurance plan and clinical indication. Over a two-year
period, 47 subjects were recruited for the study and 49 MRIs
were ordered. Date and time information was recorded for MRI
referral, registration, and completion. Descriptive statistics were
also analyzed. Image quality was also assessed from 0 (non-
diagnostic) to 5 (best anatomy delineation) by two radiologists,
consensus was subsequently reached.
Results: Of the 47 subjects, 18 completed the exam on the same
day as their referral. Median time from registration to exam
completion was 18.7 minutes. Median end-to-end reconstruction
time for the T2 Shuffling sequence was reduced from 18.8
minutes to 95 seconds using the distributed implementation.
Technical fees charged for the targeted exam were one third that
of the routine clinical knee exam. Image quality was assessed as
5/best delineation in 69.4% of cases, 4/very good in 16.3%,
3/good in 12.2% and 2/limited in 2.1%. No exams were deemed
non-diagnostic or poor quality. No subject had to return for
additional imaging.
Conclusions: The targeted knee MRI exam is feasible and
reduces imaging time, cost, and barrier to same-day MRI access
for pediatric patients.
Paper #: 136
Silent and Distortionless Diffusion MRI
Jesse Sandberg, MD1, [email protected]; Jianmin
Yuan, PhD4, Yuxin Hu5, Christopher Sandino5, Anne Menini2,
Brian Hargreaves, PhD3, Shreyas Vasanawala, MD/PhD1; 1Department of Pediatric Radiology, Lucile Packard Children's
Hospital, Stanford University, Stanford, CA, 2Application
Science Lab, GE Healthcare, Menlo Park, CA, 3Department of
Radiology, Stanford University, Stanford, CA, 4Radiological
Sciences Laboratory, Stanford University, Stanford, CA, 5Department of Electrical Engineering, Stanford University,
Stanford, CA
Disclosures: Christopher Sandino, M.S.: Financial Interest:
General Electric Healthcare - Salary: Independent Contractor;
Shreyas Vasanawala, MD/PhD: Arterys, Royalty: Arterys, GE
Healthcare, Siemens, Philips, Research Grants: GE Healthcare.
All other authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Diffusion weighted (DW) imaging is
a standard component of many MRI exams. However, with
large diffusion encoding gradients and echo-planar imaging
(EPI), DW-EPI is challenged in pediatrics by loud noise that
distresses children and may cause motion artifacts. Further,
DW-EPI suffers from image distortion, which is particularly
problematic in children and extremity imaging. Thus we aim to
develop and validate a novel silent and distortionless DWI
method.
Methods & Materials: A multi-segmented Rotating Ultra-Fast
Imaging Sequence (RUFIS) was modified with sinusoidal
diffusion preparation gradients. The images were reconstructed
with the total variation constraint. Phase cycling was used to
reduce eddy current effects. Image contrast, apparent diffusion
coefficient (ADC) and distortion were evaluated with a
diffusion phantom (Model 128, High Precision Devices,
Boulder, CO), with DW-EPI as gold standard (b50, b800).
Acoustic noise levels with DW-RUFIS, standard DW-EPI, and
no sequence were measured with a power monitor. With IRB
approval and informed consent/assent, 80 consecutive pediatric
patients (mean age 12.7 years, range 2-19) referred for
extremity scans at 3T (MR750, GE Healthcare) were recruited
(July 2018-October 2018) to undergo DW-RUFIS, and for
comparison purposes 17 of those also underwent DW-EPI. DW-
RUFIS parameters: FOV: 160x160 mm, matrix: 128x128, slice
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S128
thickness: 4mm, NEX: 2.5, b-values: 50 and 400. Scan time for
two b-values for DW-EPI is 1 minute and DW-RUFIS is 6
minutes. ADC values of both sequences in knee exams (10
cases) were compared in bone and muscle (two-sample t-test).
Artifacts were also compared.
Results: From the phantom scans, the diffusion contrast for
DW-EPI and DW-RUFIS sequences are similar (visualization of
pathology and anatomy). The ADC measurement of DW-
RUFIS correlates well with DW-EPI (R2 = 0.99). DW-EPI was
louder than RUFIS-DWI (85±2.4dB vs 54±2.4dB) and ambient
noise (51±2.8dB). In the cohort of sequential in-vivo knee
examinations, DW-RUFIS and DW-EPI ADC values in both
bone and muscle had no significant difference (p=0.88
and p=0.67 respectively). DW-EPI suffers from large image
distortion near the skin surface; while DW-RUFIS is distortion
free.
Conclusions: Silent distortionless diffusion is feasible and has
comparable diffusion contrast and ADC measurements with
conventional DW-EPI in cartilage and bone. Future work will
be directed to incorporating acceleration to shorten scan time
and assessment in other organs/applications.
Paper #: 137
Novel Functional BOLD MR Imaging Techniques for
Assessment of Juvenile Dermatomyositis: Preliminary
Results
Paymun Pezeshkpour, B.Sc.,
[email protected]; Jessica Caterini, Greg
Wells, Afsaneh Amirabadi, Carina Man, Tammy Rayner, Ruth
Weiss, Brian Feldman, Andrea Doria, MD; Hospital for Sick
Children , Toronto, Ontario, Canada
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Juvenile dermatomyositis (JDM)
causes diffuse vasculitis and proximal muscle inflammation.
Searching for highly sensitive non-invasive methods for early
diagnosis and treatment follow-up is key in this disease. We
investigated blood-oxygen level-dependent (BOLD) MRI to
detect physiologic changes at different levels of severity of JDM
as compared to age-matched healthy control subjects.
Methods & Materials: Six JDM patients of 11-15 years (12.9 ±
1.6 years) and 6 age and sex-matched healthy controls (13.29 ±
1.50 years; 6 males and 6 females) completed the study.
Participants performed 3 cycles of one-minute up-down exercise
on a MRI-compatible cycle ergometer at 65 % of maximum
workload, with 2 minutes of rest between each bout. BOLD
MRI images were acquired immediately following exercise at
3T. Parameters of 10-min BOLD EPI gradient echo sequence
were: TR/TE = 250/40 ms, flip angle = 900, FOV = 25 mm,
matrix = 64x64 and slice thickness/gap = 10/0 mm. In addition,
Childhood myositis assessment scale (CMAS) was collected as
an indicator of disease progression. BOLD signal response in
the vastus medialis (VM) and intermedius (VI) muscles during
recovery were fitted to a sigmoid model with β, half-time point
for recovery of intensity curve; α, response time and wash-out
of deoxyhemoglobin; and κ, range of recovery from baseline. in
JDM compared to healthy subjects following recovery from
exercise.
Results: A comparison of BOLD signals between control and
JDM subjects in VM and VI demonstrated a significant
difference for the first half-time point for β of VM (p = 0.04). In
addition, when adjusted for the CMAS score, the second
recovery β for VI and the first for VM were significant (p = 0.03
and 0.02). However, all other variables showed no significant
difference after adjusting for CMAS.
Conclusions: Our BOLD MRI sigmoid model at 3T allowed us
to differentiate vascular and oxygenation changes in the
quadriceps muscle between JDM and control cohorts in
recovery re-oxygenation after exercise. Therefore, BOLD MRI
may be useful to characterize early disease and monitor effects
of therapy or exercise as adjuncts to conventional laboratory and
clinical assessments of JDM.
Paper #: 138
MR-HIFU: What the Pediatric Radiologist Should Know
Narendra S. Shet, MD, [email protected]; jonathan
Zember, MD, Pavel Yarmolenko, PhD, Caitlin Tydings, MD,
AeRang Kim, MD, PhD, Karun Sharma; Children's National
Medical Center, Washington, DC
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Magnetic resonance imaging–guided
high-intensity focused ultrasound (MR-HIFU) is a novel
technology that integrates magnetic resonance imaging with
therapeutic ultrasound. Although clinical experience in
pediatrics is relatively small, the advantages of a completely
noninvasive, precise, and radiation-free tumor therapy is
especially attractive to growing children. Pediatric radiologists
should be familiar with clinical applications of MR-HIFU,
including pre- and post-procedure imaging protocols, treatment
imaging, and post-treatment imaging assessment. To this end,
we review applications of MR-HIFU in children and present
cases from our institution to highlight the post-treatment MR-
imaging findings and evolution of treated lesions over time.
Methods & Materials: Under IRB approved clinical protocols,
15 patients (age 7-21 years) with symptomatic benign (osteoid
osteoma), locally aggressive (Desmoid tumor) and refractory
malignant (Sarcoma) tumors have undergone MR-HIFU therapy
at our institution since 2017. Pre-treatment diagnostic MRI
scans, treatment imaging, and post-treatment follow-up MRI
scans were reviewed. In addition to standard musculoskeletal
MR sequences, volumetric 3D T2 weighted sequences as well
as pre- and post-contrast axial fat-saturated T1 weighted
sequences with subtraction imaging were obtained. Imaging
findings were correlated with clinical history and follow-up
course.
Results: We will present MRI findings from patients treated
with MR-HIFU. Preprocedural, intraoperative, and
postprocedural imaging findings will be discussed, and sample
MRI protocols will be presented, detailing the purpose of
essential sequences.
Conclusions: Our preliminary institutional experience with
MR-HIFU has been educational for our pediatric radiology and
oncology teams. There are currently ongoing studies for MR-
HIFU therapy for a treatment of a variety of tumors as well as
for enhanced local drug delivery. As use of this novel therapy
expands in the pediatric population, it is important for
diagnostic radiologists to have a basic understanding of the
nature of the procedure as well as what to expect on imaging
studies. Furthermore, close collaboration between radiologists
and oncologists will be essential to determine the relationship
between imaging findings and clinical response.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S129
Paper #: 139
Intra-Operative Contrast-Enhanced Ultrasound of Infant
Hips: A Comparison with Post-Operative MRI and
Correlation with Development of Femoral Head Avascular
Necrosis
Travis Matheney, MD,
[email protected]; Carol E. Barnewolt,
MD, Harriet Paltiel, M.D.; Boston Children's Hospital, Boston,
MA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Avascular necrosis (AVN) is a
significant complication following surgical treatment of infant
hip dislocation. One risk factor is post-operative decreased
femoral enhancement on contrast-enhanced MRI (CEMRI).
Ultrasound is the gold standard to evaluate infant hip dysplasia.
Contrast-enhanced ultrasound (CEUS) has been utilized for over
20 years to assess tissue perfusion in real time. The goals of this
study were to compare CEUS to CEMRI in assessing femoral
head perfusion and to compare the ability of CEUS and CEMRI
to predict AVN.
Methods & Materials: Institutional review board approval was
obtained and retrospective analysis performed of cases
undergoing closed or open reduction and intraoperative
assessment by CEUS using Perflutren microspheres
administered intravenously. This agent is currently FDA-
approved for evaluation of focal liver lesions in children. CEUS
was performed before and after hip reduction in planned casted
position. CEMRI and CEUS appearance were graded as: fully
enhancing, partially decreased or globally decreased
enhancement. Four patients underwent a second CEUS
assessment at a second procedure. Agreement between intra-
operative CEUS and early post-operative CEMRI was analyzed;
AVN was later graded following the most recent reduction at a
minimum of one year.
Results: Twenty procedures were analyzed comparing CEUS
and CEMRI. There were 16 patients, 38% male; average age 8
months (range 4-17). Sixty-eight percent were open reductions.
Agreement between enhancement grade on US and MRI was
good for normal versus partial/global decreased enhancement
(k=0.73; 95% CI = 0.24 to 1.22). Fourteen hips (70%) were
followed a minimum of 1 year post-reduction (12-45 months)
and assessed for presence of AVN. Three hips developed AVN
(21%; 95% CI = 6 to 51%). Based on ROC analysis, diagnostic
utility was nearly the same for CEUS and CEMRI ( = 0.74; 95%
CI = 0.35 to 1.00 and AUCMRI = 0.77; 95% CI = 0.39 to 1.00,
respectively). AVN was diagnosed at follow-up where
decreased enhancement was noted on CEUS in 71% (67%
sensitivity; 73% specificity) and on CEMRI in 77% (67%
sensitivity; 80% specificity). This is similar to previous CEMRI
reports after closed reduction.
Conclusions: CEUS appears to be a viable method of assessing
infant hip perfusion with overall good correlation with post-
operative CEMRI. Further study is required to determine
whether CEUS will provide adequate real-time feedback to aid
in successful reduction while reducing the incidence of
postoperative AVN.
Paper #: 140: Withdrawn
Paper #: 141
A Multidisciplinary Approach Leads to More Efficient
Magnetic Resonance Imaging, Less Use of Contrast
Material, and Improved Clinical Outcomes During
Musculoskeletal Infection Evaluation
Matthew R. Hammer, MD1
[email protected]; Eduardo A. Lindsay,
MD2, Naureen G. Tareen, MPH2, Jonathan R. Friedman, MD1,
Lawson A. Copley, MD2; 1Children’s Health / UTSW, Dallas,
TX, 2Children's Health, Dallas, TX
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: The diagnosis of musculoskeletal
infection (MSI) in children frequently involves the use of
magnetic resonance imaging (MRI), which often involves
general anesthesia and the administration of intravenous
contrast material. This study assesses the impact of a
coordinated, inter-disciplinary approach to MRI efficiency as
well as the use and utility of intravenous contrast material.
Methods & Materials: Children who underwent MRI for
possible MSI between July 2012 and June 2018 were
retrospectively studied under IRB approval. The MSI program
involved many disciplines, including radiology and
orthopaedics, which met before and during the scans for
planning and immediate study interpretation to guide surgical
decision making. Data collected included: MRI duration and
parameters, use of intravenous contrast material, percentage of
children taken to surgery immediately following MRI, and
satisfaction with the hospital experience. Kruskal-Wallis test
was used to periodically assess process improvement, followed
by multiple comparisons using a Mann-Whitney test with
Bonferroni Adjustment (alpha=0.017). A fisher’s exact test was
used to compare periodic improvement for categorical data
(p<0.05).
Results: There were 526 children evaluated during the study
period. MRI scan duration decreased from a mean of 81.7
minutes in 2012 to 24.4 minutes per study in 2018. This was
attributed to scanning of fewer body areas (2.6 vs. 2.0) and
obtaining fewer sequences per scan (8.2 vs. 3.9). In 2012,
87.8% of children received intravenous gadolinium-based
contrast material compared to 8.5% in 2018. Contrast material
administered was felt to be beneficial retrospectively in only
4.3% (15/346). Procedures were performed immediately after
the MRI under continued anesthesia on 54.5% of children with
indications in 2012, compared to 85.7%% in 2018. NRC Picker
Satisfaction rating rose from 91% in 2012 to 100% in 2018. All
differences were statistically significant (p<0.05).
Conclusions: A multidisciplinary team approach produced
consistent improvement over time as evidenced by decreased
MRI scan time, fewer sequences per scan, decreased use of
intravenous contrast, and a higher rate of definitive procedures
immediately following the MRI while under continued
anesthesia. This study supports the practice of minimizing
contrast use for children with suspected musculoskeletal
infection with a team approach that improves patient care and
satisfaction.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S130
Paper #: 142
Value of Functional T2 Map MRI in the Assessment of
Early Cartilage Degeneration of Pediatric Patients with
Hemophilia
Haris Majeed, BSc1, Marshall Sussman, PhD2, Brian Feldman1,
Carina Man1, Victor Blanchette1, Andrea Doria, MD1,
[email protected]; 1The Hospital for Sick Children,
Toronto, Ontario, Canada, 2Toronto General Hospital, Toronto,
Ontario, Canada
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Despite efforts of clinical research
for hemophilia, evaluating internal cartilagederangement has
been challenging. T2 map MRI enables identification of
disarrangements in collagen fibers alignment prior to
macroscopic cartilage degeneration in hemophilic arthropathy.
Thus, recognizing relationships between cartilage maturation
and degeneration by T2 map MRI is key in children/adolescents
with hemophilia and age-matched control boys.
Methods & Materials: A cross-sectional study was conducted
in ankles of males with hemophilia (n = 19) and of healthy
controls (n = 16, aged 7-17 years), and in knees of males with
hemophilia (n = 9) and of healthy controls (n = 7, aged 5-17
years) employing a multiecho spin-echo T2-weighted sequence
at 3.0 T. T2 map relaxation times of pathologic ankle (tibia-
talus) and knee (femur-tibia) cartilages were compared to that of
age- and sex-matched healthy individuals and with a clinical
structural MRI scale, the International Prophylaxis Study Group
(IPSG) scale. An associational analysis was performed of
pediatric age versus T2 relaxation times for ankle/knee
cartilage.
Results: Predominantly significant differences were found
between median T2 map relaxation times for hemophilia and
healthy subjects' ankles/knees. Mean T2 map relaxation times in
hemophilic and healthy ankles ranged from 36.6-59.4 ms,
whereas 39.8-54.4 ms in the knees.Strong negative associations
were found between pediatric age and T2 map relaxation times
for the cartilage of hemophilia and healthy subjects'
ankles/knees. Hence suggesting that T2 map relaxation times in
ankle/knee cartilage decrease with increasing pediatric age,
regardless of healthy or pathologic status of joints. We assessed
the estimated mean of ankle/knee cartilage T2 map relaxation
times by combining age, soft tissue, osteochondral, and total
IPSG scores at 4 regions of interest in a multilinear regression
model. Regression coefficients were found statistically
significant for age for all regions in both ankles and knees.
Mean mean regression coefficient for age was -1.5 ms/year (P <
0.01), while holding structural MRI joint scores constant.
Conclusions: T2 map MRI can be used as an adequate measure
to study future cartilage degeneration in pediatric patients with
hemophilia, allowing clinicians to better understand disease
progression and manage treatment decisions.
Paper #: 143
Role of DWI in detecting early satage of sacroiliac joint
lesions in children with enthesitis related arthritis
Lin Xu, [email protected]; Yumin Zhong; Shanghai
Children's Medicial Center, Shanghai, China
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To investigate value of DWI in
detecting early inflammation of sacroiliac joints in children with
enthesitis related arthritis (ERA).
Methods & Materials: Totally 20 patients with clinical
diagnosed ERA (ERA group) and 20 normal children (control
group) were enrolled, all of them were aged 6-16 years old. The
MRI were performed, including T1WI, spectral attenuated
inversion recovery (SPAIR) T2WI and DWI (b value were 0
and 400 s/mm2). The MRI feasures of sacroiliac joints were
observed. The ADC value of all sacroiliac joints were measured
and were compared between the two groups. The ROC curve
was used to evaluate the diagnositc efficacy of ADC value on
ERA.
Results: In ERA group, 17 patients showed high signal intensity
at sacroiliac joints on SPAIR images and 3 were normal, and 16
patients showed high signal intensity on DWI and 4 were
normal. In control group, 12 children were nornal on SPAIR
images and 8 showed high signal intensity at sacroiliac joints,
and15 children were nornal on DWI images and 5 showed high
signal intensity. The ADC value in ERA group and control
group was (1.24±0.32)×10-3 mm2/s and (0.69±0.24)×10-3
mm2/s, respectively (t=14.466, P=0.001). Taking
ADC=0.87×10-3 mm2/s as the threshold, the AUC of ROC
curve in diagnosis of ERA were 0.834 (P=0.023), with the
sensitivity, specificity and diagnostic accuracy, of 87.50%,
77.50% and 82.50%, respectively.
Conclusions: DWI is a sensitive method for displaying the
inflammation of the sacroiliac joint in patiens with ERA.
Quantitive analysis of ADC value shows high value in detecting
the early inflammation in the sacroiliac joints.
Paper #: 144
Stable versus unstable osteochondral lesions of the elbow:
Performance of MR imaging criteria for instability
Jie C. Nguyen, MD, MS1, [email protected]; Andrew
J. Degnan, MD, MPhil1, Theodore Ganley, MD1, Christian A.
Barrera, M.D.1, Thor Perrin Hee1, Richard Kijowski, MD2; 1Radiology, Children's Hospital of Philadelphia, Philadelphia,
PA, 2University of Wisconsin, Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To retrospectively compare the
performance of previously described magnetic resonance (MR)
imaging criteria for the detection of instability in children with
osteochondral lesions (OCL) of the elbow with clinical and
arthroscopic findings as reference standards.
Methods & Materials: This IRB-approved, HIPAA compliant
retrospective study included 45 elbow OCLs with MR studies
from 43 children (mean age 13.1 years; range 9-17 years, 27
boys & 16 girls) diagnosed between April 1 2010 and May 31,
2018. Twenty-one lesions were stable, determined using
arthroscopy or clinical assessment and 24 lesions were unstable,
determined during arthroscopy. Two radiologists, blinded to
clinical data, reviewed to determine the presence T2 high signal
intensity rim, T2 dark signal intensity rim, surrounding cysts,
subchondral disruption, overlying cartilage degeneration, fluid-
filled osteochondral defect, and intra-articular fragments. The
inter-observer agreement was evaluated with weighted-kappa.
Kappa scores (k) of 0.41– 0.60, 0.61– 0.80 and ≥ 0.80 were
regarded to be indicative of moderate, good, and excellent
agreement, respectively. Fisher Exact and Mann Whitney U
tests were used.
Results: Demographic characteristics of children with stable
and unstable OCLs demonstrated no difference in age (p =
0.638) or symptom duration (p = 0.646). Fluid-filled
osteochondral defects (k = 0.76, p = 0.02) and the presence of
subchondral disruption (k = 0.81, p = 0.01), overlying cartilage
degeneration (k = 0.79, p = 0.006), and intra-articular fragment
(k = 0.66, p = 0.01) were significantly more common with
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S131
unstable OCLs. Lesion size (p = 0.337) and the presence of T2
high signal intensity rim (k = 0.78, p = 0.28), T2 dark signal
intensity rim (k = 0.65, p = 0.68), and surrounding cysts (k =
0.70, p = 0.19) were not significantly different between stable
and unstable OCLs. Although, unstable OCLs were more likely
to have larger cysts (up to 7mm) and more cysts (up to 5 cysts)
than stable OCLs (up to 5mm and up to 2 cysts, respectively).
Conclusions: Only some of the previously described MR
imaging criteria for lesion stability for the knee joint can be
applied to predict stability of lesions in the elbow joint. This
may be due to the high prevalence of unstable lesions presenting
with a displaced fragment at the time of diagnosis.
Paper #: 145
Abdominal Wall Thickness in Children Correlates with
Hepatic Steatosis
Lisa K. Harris, MD1, [email protected];
Nicholas Dubay2, Sandra M. Allbery, MD1, Jihyun Ma3; 1Children's Hospital and Medical Center, Omaha, NE, 2Creighton University, Omaha, NE, 3University of Nebraska
Medical Center, Omaha, NE
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Pediatric obesity is a serious health
concern that affects 18.5% of US children and adolescents, but
is significantly under reported by radiologists on imaging. The
purpose of this study is to evaluate for any association of lateral
abdominal wall thickness (LAWT) with histopathologic hepatic
steatosis or other serious medical conditions. This may have
implications on radiologic reporting of obesity.
Methods & Materials: IRB approval obtained. Retrospective
imaging and chart review performed on all patients undergoing
ultrasound guided liver biopsy at tertiary care children’s
hospital during a 5 year period (03-01-2013 to 03-01-2018).
Images reviewed to record LAWT in the mid axillary line,
obtained to gauge needle depth for the biopsy. LAWT was
measured from the skin surface to the liver capsule. Medical
records reviewed for age, sex, BMI, blood pressure, cholesterol
levels, diagnosis of diabetes, and histopathologic biopsy result.
Descriptive statistics included counts and percentages for
categorical data and means, standard deviations, medians,
minimums and maximums for continuous data. Pearson
correlation coefficients were used to describe association of
LAWT variable with other continuous variables. Two by two
tables were presented to evaluate accuracy, sensitivity,
specificity, positive predictive value, and negative predictive
value for steatosis. ANOVA and Chi-square test were used to
determine the dependency of the LAWT measure. P<0.05 was
considered statistically significant.
Results: 166 liver biopsies in 151 patients, 95 male and 56
female, were reviewed. Hepatic steatosis with or without
fibrosis was present in 67/166 (40.4%) of patients; 4/51 (7.8%)
age 0-4, 6/16 (37.5%) age 5-9, and 57/99 (57.6%) age 10-19.
There was a statistically significant association between LAWT
and histopathologic hepatic steatosis ( p <0.001), BMI
independent of age (p <0.0001), systolic blood pressure in
patients 10-19 (p <0.0001), and diagnosis of diabetes mellitus
type 2 (p < 0.002). Sensitivity, Specificity, PPV, and NPV for
LAWT predicting hepatic steatosis were 65.7%, 90.9%, 83%,
79.7% for >2 cm thickness and 37.3%, 99%, 96.2%, 70% for >
2.67 cm thickness, respectively.
Conclusions: Our results suggest that increasing lateral
abdominal wall thickness correlates with statistically significant
increased frequency of hepatic steatosis and other serious
medical conditions; therefore, radiologists should consider
reporting this finding.
Paper #: 146
Automated Sonographic Assessment of Fatty Liver in
Pediatric Patients
Eugene Cheah1, Theodore T. Pierce, M.D.1, Arinc Ozturk,
MD1, Masoud Baikpour1, Laura Brattain1, Michael S. Gee2,
[email protected]; Anthony E. Samir, M.D.1; 1Center
for Ultrasound Research & Translation, Department of
Radiology, Massachusetts General Hospital, Boston, MA, 2Division of Pediatric Radiology, Department of Radiology,
Massachusetts General Hospital, Boston, MA
Disclosures: Anthony E. Samir, M.D.: Consultant, Honoraria:
General Electric, Pfizer, Bristol Myers Squibb, Research
Grants: General Electric, Phillips. All other authors have
disclosed no financial interests, arrangements or affiliations in
the context of this activity.
Purpose or Case Report: To demonstrate the feasibility and
accuracy of automatically extracted sonographic skin-to-liver-
capsule distance (SCD) measurement as a biomarker for fatty
liver in the pediatric population.
Methods & Materials: This institutional review board
approved single-institution retrospective study evaluated
consecutive pediatric patients, ages 2 to 18, who underwent
abdominal ultrasound from February 2018 to September 2018.
Diagnosis of fatty liver, obtained through the electronic medical
record, was recorded on the basis of clinical notes, prior
imaging tests, and liver biopsy pathology when available. Body
mass indices (BMI) and normalized Z-scores using CDC’s
growth charts, were also extracted. Duplicate patients and those
with absent clinical information or imaging were excluded.
Using manually measured SCD as a reference standard, an
image processing algorithm was developed to automatically
extract the SCD measurement from manually selected B-mode
images (one image per patient). Image processing steps
included: 1) Region of Interest (ROI) placement, 2) image
denoising (Gaussian filter), 3) contrast enhancement, 4) canny
edge detection, 5) connected components detection using the
binary image derived from step 4, 6) skin and Glisson capsule
border detection, and 7) SCD calculation (distance between the
detected skin and capsule). Receiver operating characteristic
(ROC) curve analysis was performed to assess the diagnostic
performance of BMI Z-scores and the SCD measurements for
fatty liver.
Results: 174 patients, including 26 with hepatic steatosis, were
analyzed (mean age 125.6±54.1 months, 74 males, 100
females). The root-mean-squared error (RMSE) between
manually and automatically extracted SCD measurements was
5.06 mm. The area under the ROC curve (AUROC) for
prediction of fatty liver was calculated to be 0.905 (95%CI:
0.856-0.954) for the BMI Z scores, 0.889 (95%CI: 0.818-0.961)
for the manual SCD measurements, and 0.770 (95%CI: 0.668-
0.873) for the algorithm-measured SCD.
Conclusions: In addition to BMI, sonographic SCD can be
considered as a biomarker of hepatic steatosis. Measurement of
SCD can be automated with acceptable accuracy. The benefits
of using sonographic SCD rather than liver echogenicity as a
biomarker are threefold: 1) it is faster, 2) can be performed at
the point of care, and 3) reduces operator dependence compared
with interpretation of B-mode ultrasound liver images.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S132
Paper #: 147
Biexponential T2* relaxation model for estimation of liver
iron concentration in children: A better fit for high liver
iron concentrations
Christian A. Barrera, M.D., [email protected];
Dmitry Khrichenko, Suraj Serai, Helge Hartung, David M.
Biko, MD, Hansel J. Otero, MD; Radiology, The Children's
Hospital of Philadelphia, Philadelphia, PA
Disclosures: David M. Biko, MD: Financial Interest: Wolters
Kluwer - Royalty: Editor of Review Book. All other authors
have disclosed no financial interests, arrangements or
affiliations in the context of this activity.
Purpose or Case Report: To compare biexponential analysis of
T2* relaxation of the liver in children with iron deposition
disease to the more commonly used monoexponential model
and establish its relation with different levels of iron overload in
children.
Methods & Materials: All MRI studies performed for
determination of liver iron concentration (LIC) performed in our
institution between 2007 and 2017 that included T2* sequences
were included. LIC was calculated using Monoexponential T2*
(MonoExp) and Biexponential T2* (BiExp) models using both
commercially available and an in-house developed software.
The calculations were based on ROIs including the entire liver
(ROI1), the periphery of the liver (excluding the major vessels)
(ROI2) and the spleen (ROIcontrol). The LIC results were
classified as normal (< 3.2 mg/dL), mild (3.2 - 7 mg/dL),
moderate (7 - 15 mg/dL), and severe (> 15 mg/dL) as per
commonly used treatment guidelines. Residuals and residuals
ratios were calculated for each model (MonoExp and BiExp) in
order to identify the best fitting model on each LIC category. A
MonoE/BiExp residual ratio > 1.5 was considered to have a
biexponential trend. Non-parametric tests and correlations were
used, p < 0.05 was considered significant.
Results: 182 patients (110 boys, 71 girls) with a mean age of
12.3 years (range or SD) were included in the analysis. For both
ROI1 and ROI 2, there was a near perfect agreement between
MonoExp using the commercial and the in-house software (r =
0.98, p < 0.001, and r = 0.99, p < 0.001, respectively).
According to the MonoExp/BiExp residual ratio, the BiExp
model fits better in patients with a LIC > 15 mg/dL (ROI1: ratio
= 11.5, p < 0.001 and ROI2: ratio = 2.3, p < 0.001). For those
with a biexponential best fit (n = 38), the proportion of slow
(second) component was 0.06 (range 0.01 - 0.11). In the internal
control ROI (spleen), the MonoExp/BiExp ratio was not
significantly different among different LIC categories (p =
0.46).
Conclusions: Biexponential T2* relaxation model for LIC
estimation fits better than the monoexponential model in
patients with severe iron overload (LIC > 15 mg/dL) and can be
used to more accurately determine LIC in these patients. The
proportion of slow (second) component of the model might be
related to the intra-cellular iron in the liver.
Paper #: 148
R2-Relaxometry MRI for estimation of Liver Iron
Concentration. A comparison between two methods.
Juan S. Calle Toro, MD, [email protected]; Christian A.
Barrera, M.D., Kassa Darge, MD, PhD, Hansel J. Otero, MD,
Suraj Serai; Radiology, Children’s Hospital of Philadelphia,
Philadelphia, PA
Disclosures: Kassa Darge, MD, PhD: Research Grants:
Bracco, Lantheus, Siemens, Philips, NIH, Thrasher Society,
Helfer Society, ITMAT, Foerderer, MTR, RSNA, SPR. All
other authors have disclosed no financial interests, arrangements
or affiliations in the context of this activity.
Purpose or Case Report: To assess the reproducibility and
accuracy of R2-relaxometry MRI for estimation of liver iron
concentration (LIC) between non-proprietary in-house-
developed software and FDA-approved commercially available
third party results.
Methods & Materials: All MR studies were performed in a
1.5T scanner. Multiple spin-echo scans with a fixed TR and
increasing TE values of 6ms, 9ms, 12ms, 15ms and 18ms
(spaced at 3ms intervals) were used based on methodology
reported by St. Pierre et al. Post-processing of the images to
calculate R2 included drawing of regions of interest (ROIs) to
include the whole liver on mid-slice. The relationship between
liver R2 values calculated with in-house nonproprietary
software and values calculated by an external company
(FerriScan®, Resonance Health, Australia) was assessed with
correlation coefficient and Bland-Altman difference plot.
Continuous variables are presented as mean ± standard
deviation. Significance was set at p value < 0.05.
Results: 463 studies from 175 patients were included in the
study (Mean age 10.44 ± 4.18 years (range 1 to 18 years); Girls
245, Boys 218). LIC ranged from 0.8-43 mg/g dry tissue,
covering a broad range from normal levels to extremely high
iron levels. Linearity between proprietary and non- proprietary
methods was excellent across the observed range for R2 (31.5 to
334.8 s-1). With the exception of borderline outliers on <30
studies, all other studies fell within 95% prediction limits
(correlation coefficient for R2, r = 0.8, p<0.001). Bland-Altman
R2 difference between the two methods show a mean bias of
17.8ms (range: -68.2 to 103.9ms between two standard
deviations).
Conclusions: R2 Relaxometry MR imaging for liver iron
concentration estimation is reproducible between FDA-
approved commercially available and non-proprietary analysis
methods.
Paper #: 149
Magnetic Resonance Elastography of the Liver in Children:
Variations in Regional Stiffness
Anand Shankar, Ramkumar Krishnamurthy, PhD, Carol
Potter, Cheryl Gariepy, Houchun Hu, PhD, Rajesh
Krishnamurthy, Benjamin P. Thompson,
[email protected]; Radiology, Nationwide
Children's Hospital, Columbus, OH
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Liver Magnetic Resonance
Elastography (MRE) is a non-invasive technique to measure the
stiffness of hepatic tissue in vivo. In clinical practice MRE is
used as an alternative to biopsy in evaluating liver stiffness.
Many studies have demonstrated that liver stiffness directly
correlates with liver fibrosis. Several studies of liver fibrosis in
post mortem autopsies have proven that liver fibrosis is a
heterogeneous process. There is an abundance of scientific
literature evaluating global liver stiffness. Few studies have
assessed regional liver stiffness variations in children using the
eight Couinaud liver segments.
Methods & Materials: This retrospective IRB approved study
involved 170 children who underwent MRE at 3T on a GE
platform using a commercial 2D SE-EPI pulse sequence.
Regional liver stiffness was measured at the locations of the
Couinaud segments by a trained analyst. In each patient, the
segment exhibiting maximum stiffness was recorded. The
coefficient of variation (CoV=standard deviation/mean) across
the eight segments was also computed. A higher CoV signifies
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S133
greater stiffness heterogeneity. Medical history was obtained
from patient records and the cohort was stratified into five
major disease groups, including: Nonalcoholic Fatty Liver
Disease(NAFLD) (N=119), autoimmune disease (N=22), heart
and cardiovascular conditions (N=4), genetic disorders (N=12)
and “others”, which included cystic fibrosis, portal vein
thrombosis, ductal plate malformations and liver tumors
(N=13). Statistical analysis was performed using R software.
Results: A wide range of regional variations in liver stiffness
were observed (CoV=17.2 ± 7.3%, range =3.1-79.2%) across
the cohort. Of the 170 patients, segments II and VII exhibited
the highest stiffness, each in 29 patients. Patients with NAFLD
displayed a significantly higher CoV (17.17±5.5%) compared to
patients with autoimmune diseases (14.65±4.2%, p=0.019). No
other significant differences in stiffness heterogeneity were
observed.
Conclusions: We observed significant variations in liver
stiffness across the eight Couinaud segments in 170 pediatric
patients, with segments II and VII frequently exhibiting
maximum stiffness. There were notable variations in stiffness
heterogeneity between patients with NAFLD and autoimmune
disease. Our results suggest that underlying disease conditions
can potentially influence the degree of regional stiffness
heterogeneity. Measuring regional stiffness may also better
guide targeted biopsies and interventions for the patient.
Paper #: 150
Technical Success Rate of Two-Dimensional Ultrasound
Shear Wave Elastography in a Large Pediatric and Young
Adult Population: A Clinical Effectiveness Study
Nathan Northern, BS2, [email protected]; Jonathan R.
Dillman, MD. MSc1, Andrew T. Trout1; 1Department of
Radiology, Cincinnati Children's Hospital Medical Center,
Cincinnati, OH, 2University of Cincinnati College of Medicine,
Cincinnati, OH
Disclosures: Nathan Northern, BS: Financial Interest: Canon
Medical Systems USA - Grant (unrelated to this research);
Jonathan R. Dillman, MD, MSc: Research Grants: Canon
Medical Systems; Siemens Healthineers; Perspectum
Diagnostics; Bracco Diagnostics, Other: Travel Support (Philips
Healthcare, GE Healthcare); Andrew T. Trout, MD:
Consultant, Honoraria: Guerbet Group, Royalty: Elsevier,
Wolters-Kluwer, Research Grants: Canon Medical, Siemens
Medical Solutions, National Pancreas Foundation, In-Kind
Support: ChiRhoClin Inc., Perspectum Diagnostics. All other
authors have disclosed no financial interests, arrangements or
affiliations in the context of this activity.
Purpose or Case Report: To determine the frequency of
technical success of two-dimensional ultrasound (US) shear
wave elastography (SWE) in a large pediatric and young adult
cohort based on the interquartile range (IQR)/median of 10
shear wave speed (SWS) measurements.
Methods & Materials: This retrospective study was IRB
approved, and the requirement for informed consent was waved.
All patients that underwent 2D US SWE between February
2016 and March 2018 were identified. For each patient, records
were reviewed for: age, sex, median liver stiffness (10 SWS
measurements), mean liver stiffness (10 SWS measurements),
IQR/median, anterior abdominal wall thickness, and serum
alanine aminotransferase (ALT). The number of non-diagnostic
examinations was calculated using three methods: 1)
IQR/median >0.3; 2) IQR/median >95th percentile for our study
population; and 3) identification of statistical outliers using the
Tukey method. The effect of age, sex, median SWS, anterior
abdominal wall thickness, BMI, and ALT on IQR/median was
assessed using multivariable linear regression, with model
selection based on the highest adjusted-R2 value. The
relationship between median and mean SWS was evaluated
using Lin’s concordance correlation coefficient (rc).
Results: 573 patients underwent clinical US SWE. Mean age
was 12.6 years; 274 (47.8%) patients were male. Average
median liver stiffness was 1.75 ± 0.47 kPa, while the average
mean liver stiffness was 1.75 ± 0.47 kPa (rc=0.994 [95%
confidence interval: 0.993-0.995]; p<0.0001). Based on
methods 1, 2 and 3, 29/573 (5.1%), 28/573 (4.9%,
IQR/median=0.303), and 30/573 (5.2%) exams were non-
diagnostic. Significant predictors of IQR/median at regression
included age (p=0.02), BMI (p=0.0011), median SWS
(p<0.0001), and ultrasound transducer (p<0.0001).
Conclusions: Approximately 95% of US SWE exams are
technically successful based on IQR/median. IQR/median is
impacted by patient age, BMI, median SWS, and ultrasound
transducer.
Paper #: 151
Biliary atresia versus other causes of neonatal jaundice:
What is the value of Shear Wave Elastography
complementing grayscale findings?
Jesse Sandberg, MD1, [email protected]; Yinghua
Sun, MD2, Zhaoru Ju, MD2, Shaoling Liu, MD3, Jingying
Jiang4, Martin Koci, MD5, Martin Willemink5, Jarrett
Rosenberg6, Erika Rubesova, MD1, Richard Barth, MD1; 1Department of Pediatric Radiology, Lucile Packard Children's
Hospital, Stanford University, Stanford, CA, 2Ultrasonography
Unit, Children's Hospital of Fudan University , Shanghai,
China, 3Ultrasound Department, Shandong Provincial Medical
Imaging Research Institute, Jinan City, China, 4Shanghai
Medical College, Fudan University, Shanghai, China, 5Department of Radiology, Stanford University School of
Medicine, Stanford, CA, 6Radiological Sciences Laboratory,
Stanford University, Stanford, CA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Ultrasonography (US) is a useful
non-invasive test in the workup of neonatal jaundice to rule out
biliary atresia (BA). Despite strong US findings that suggest
BA, namely fibrotic cord sign and absent gallbladder (GB);
accuracy in diagnosing BA from US alone remains difficult.
Prior ultrasound studies have evaluated shear wave elastography
(SWE) in infants with neonatal jaundice, however cohort size
was small. We aim to assess the diagnostic performance of
SWE in discriminating BA from other causes of neonatal
jaundice in the largest cohort of BA cases to date.
Methods & Materials: Between 11/2017–08/2018, 172
consecutive infants (age 9-93 days at time of US) with jaundice
were prospectively evaluated with greyscale US and SWE
(Siemens S3000). On greyscale, we recorded liver
heterogeneity, fibrotic cord sign (FCD), enlarged HA (>2mm),
presence/absence of GB/common bile duct (CBD) and GB size.
SWE velocity (meters/second) were performed using 4 different
techniques C6 VTQ1 (2.5 cm depth), C6 VTQ2 (3.5cm), L9
VTQ (2.5cm) and L9 VTIQ in hepatic segments V or VI.
Normality was assessed with Kolmogorov-Smirnov test.
Analysis was assessed with Spearman correlation coefficients,
chi-squared, logistic regression models and area under the ROC
curve (AUC).
Results: There were 105 BA (biopsy confirmed) and 67 non-
BA cases. Median and interquartile range for SWE velocity for
BA using C6VTQ1 / C6VTQ2 / L9VTQ / L9VTIQ was
1.94(1.59-2.3) / 1.86(1.66-2.2) / 2.17(1.76-2.52) / 2.19(1.89-
2.46), significantly higher (p<0.001) when compared to non-BA
1.45(1.27-1.76) / 1.46(1.28-1.69) / 1.48(1.3-1.9) / 1.77 (1.61-
2.01). Stratified by age (≤69 days vs >69 days), SWV difference
for both BA and non-BA was statistically significant (p<0.001).
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S134
On ROC analysis, AUC was 0.787 for L9VTQ. For a SWV
cutoff value of 1.66 m/s, sensitivity/specificity for BA was
80.8%/65.2%. All greyscale US findings were significantly
different between BA/non-BA (p<0.001). FCD had the highest
sensitivity for BA. Although sensitivity is the same for SWE
and FCD (80% vs 80.8%), FCD was markedly more specific
(97.1% vs 65.2%). On greyscale, FCD (odds-ratio (OR) 31.5,
95% CI: 5.6-178.6), absent CBD (OR 11.1, CI 1.6-78.6) and
enlarged HA (OR 5.5, CI 1.4-21.3) were significant. Combining
SWE with US findings improved diagnosis with only absent
CBD (OR 12.7).
Conclusions: SWE is feasible in evaluating neonatal jaundice
and differentiating BA from non-BA. However, for the majority
of greyscale US imaging findings, SWE does not increase
diagnostic value.
Paper #: 152
Quantitative assessment of liver stiffness and perfusion
using shear wave elastography and dual energy computed
tomography in hepatic veno-occlusive disease in rabbit
model
Hyun Joo Shin, MD, PhD, [email protected]; Jaeseung
Shin, Yoon Jin Cha, Kyunghwa Han, Myung-Joon Kim, Mi-
Jung Lee; Department of Radiology, Severance Hospital,
Yonsei University College of Medicine, Seoul, Korea (the
Republic of)
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To know the usefulness of shear
wave elastography (SWE) and dual energy computed
tomography (DECT) for the diagnosis of hepatic veno-occlusive
disease (VOD) in rabbit model.
Methods & Materials: Among six New Zealand white rabbits
(3-4 kg, male), three rabbits had normal saline ingestion
throughout 20 days and grouped as normal group. Another three
rabbits had 6-thioguanine (6-TG, 5mg/kg/day) ingestion
throughout 20 days and grouped as VOD group. Liver stiffness
was measured using supersonic shear wave imaging on baseline,
3, 10, and 20th days. Liver perfusion was evaluated using
DECT with fast kVp switching (80/140 kVp) on the same days.
Three region-of-interests (ROIs) were drawn in liver
parenchyma using virtual monochromatic images (VMI) of 55
keV and iodine maps. Morphologic changes of liver including
periportal, gallbladder wall edema, or diameter change of
hepatic veins were assessed on 20th day using CT. Final
pathologic score of VOD was evaluated on the 21st day after
sacrifice and compared between two groups using Mann-
Whitney U test. Linear mixed model was used to know the
differences of liver stiffness and perfusion parameters between
two groups. Spearman correlation test was used to know the
correlation between liver stiffness, perfusion parameters and
pathologic scores.
Results: Final pathologic scores were significantly higher in
VOD group than in normal group (median 22, 2, p=0.046).
There was no gross morphologic change in the livers in CT.
Liver stiffness values using SWE, Hounsfield unit (HU) values
using VMI, and iodine concentration values using iodine map
were significantly higher in VOD group compared with normal
group on 10th and 20th days (all, p≤0.03). Compared to the
baseline values, liver stiffness values and iodine concentrations
became significantly higher in 20th day in VOD group
(p=0.001, <0.001, respectively), while it were not different in
normal group. Liver stiffness and iodine concentration showed
positive correlation with final pathologic scores (all, r=0.754).
Conclusions: Liver stiffness values from SWE and iodine
concentration values from DECT were significantly increased in
hepatic VOD model in rabbits. SWE and DECT could aid the
diagnosis of hepatic VOD, while morphologic change was not
apparent in the liver.
Paper #: 153
Normal Liver and Pancreas Shear Wave Stiffness in
Healthy Children
Andrew T. Trout, MD, [email protected]; Jonathan R.
Dillman, MD. MSc, Samantha M. Summers, BS, MA, Paula S.
Bennett; Radiology, Cincinnati Children's Hospital Medical
Center, Cincinnati, OH
Disclosures: Andrew T. Trout, MD: Consultant, Honoraria:
Guerbet Group, Royalty: Elsevier, Wolters-Kluwer, Research
Grants: Canon Medical, Siemens Medical Solutions, National
Pancreas Foundation, In-Kind Support: ChiRhoClin Inc.,
Perspectum Diagnostics; Jonathan R. Dillman, MD, MSc:
Research Grants: Canon Medical Systems; Siemens
Healthineers; Perspectum Diagnostics; Bracco Diagnostics,
Other: Travel Support (Philips Healthcare, GE Healthcare). All
other authors have disclosed no financial interests, arrangements
or affiliations in the context of this activity.
Purpose or Case Report: Ultrasound shear wave elastography
(SWE) is being increasingly used as a non-invasive means of
measuring tissue stiffness which reflects pathologic processes
including fibrosis, inflammation and congestion. Consensus
guidelines suggest cut-off liver stiffness values for disease in
adults but there are limited data on normal values for children.
For the pancreas, understanding normal pancreas stiffness might
be of value for future detection of diffuse pancreatic disease,
including chronic pancreatitis. The purpose of this study was to
define normal stiffness values measured in terms of ultrasound
shear wave speed (SWS) for the liver and pancreas in the
pediatric population and to assess for associations with patient
sex, age and size.
Methods & Materials: In this prospective, IRB approved
study, 121 healthy children with body mass index (BMI)
<85th percentile and without a history of liver disease underwent
2D SWE of the liver and pancreas with a Canon Aplio i800
ultrasound system using a i8CX1 probe. 10 liver stiffness
measurements were obtained in the right hepatic lobe and 5
pancreas stiffness measurements were obtained in the pancreatic
body or tail, all using a manually placed region of interest (1 cm
in the liver, 0.5 cm in the pancreas). Descriptive statistics were
utilized to summarize continuous data. T-tests and Pearson
correlation were used to define relationships between SWS and
predictor variables.
Results: Mean age for the 121 children was 6.56±5.61 years
(range: 0.02-17.81 years), mean BMI percentile was
39.7±26.8%, and 62 (51.2%) were female. The majority of
children (87.6%, 106/121) were white, non-Hispanic. Mean
median liver SWS for the population was 1.29±0.14 m/s. Mean
median pancreas SWS for the population was 1.31±0.15 m/s.
There were weak but statistically significant correlations
between median liver SWS and age (r=0.29, p=0.001), height
(r=0.32, p=0.00038), and weight (r=0.31, p=0.00045) but there
were no significant correlations between pancreas SWS and any
measure of subject size. There was no significant difference in
liver or pancreas SWS based on sex and there was no significant
correlation between liver and pancreas SWS.
Conclusions: We report normal liver and pancreas stiffness
values for healthy children ages 0-17 years. Liver SWS >1.56
m/s and pancreas SWS >1.61 m/s likely reflect abnormal
stiffening (>95th percentile) that may be indicative of diffuse
disease.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S135
Paper #: 154
Use of Clinical and Quantitative Magnetic Resonance
Cholangiopancreatography Parameters for Differentiating
Autoimmune Liver Diseases
Leah A. Gilligan, MD, [email protected]; Andrew T.
Trout, Simon Lam, MD, Alexander G. Miethke, MD, Jonathan
R. Dillman, MD. MSc; Radiology, Cincinnati Children's
Hospital Medical Center, Cincinnati, OH
Disclosures: Andrew T. Trout, MD: Consultant, Honoraria:
Guerbet Group, Royalty: Elsevier, Wolters-Kluwer, Research
Grants: Canon Medical, Siemens Medical Solutions, National
Pancreas Foundation, In-Kind Support: ChiRhoClin Inc.,
Perspectum Diagnostics; Jonathan R. Dillman, MD, MSc:
Research Grants: Canon Medical Systems; Siemens
Healthineers; Perspectum Diagnostics; Bracco Diagnostics,
Other: Travel Support (Philips Healthcare, GE Healthcare). All
other authors have disclosed no financial interests, arrangements
or affiliations in the context of this activity.
Purpose or Case Report: Primary/autoimmune sclerosing
cholangitis (PSC/ASC) and autoimmune hepatitis (AIH) have
overlapping clinical and imaging features but distinct
management strategies. The purpose of this study was to assess
clinical and novel quantitative magnetic resonance
cholangiopancreatography (MRCP) parameters for
distinguishing PSC/ASC and AIH in children and young adults.
Methods & Materials: This cross-sectional study was approved
by the institutional review board and included participants in
our institution’s autoimmune liver disease registry who
underwent baseline laboratory (ALT, AST, GGT, alkaline
phosphatase, total bilirubin) and MRI evaluation with 3D
MRCP. The biliary tree was extracted from MRCP images
(Perspectum Diagnostics; Oxford, UK) and 15 quantitative
parameters were generated (e.g., numbers of visible ducts,
strictures, and dilated ducts; total lengths of biliary tree,
strictures, and dilated ducts; median and maximum duct
diameter; biliary tree volume). Mann-Whitney U test was used
to compare patient groups (clinical diagnosis of PSC/ASC vs.
AIH). Multivariable logistic regression with receiver operating
characteristic curves were used to assess diagnostic
performance.
Results: There were 29 patients (mean age=14.7±4.1 years); 14
with PSC/ASC; 15 with AIH. Numbers of bile duct strictures
(p=0.0057) and dilations (p=0.007), total length of dilated bile
ducts (p=0.004), and maximum common bile duct (CBD)
diameter (p=0.046) were significantly different between groups.
There was no significant difference between groups in any
laboratory value (all p-values >0.05). The best regression model
for distinguishing PSC/ASC from AIH was total length of
dilated ducts, maximum CBD diameter, GGT, ALT, and age
(p=0.014, AUC=0.90).
Conclusions: The combination of laboratory and quantitative
MRCP parameters provides good discrimination of PSC/ASC
from AIH.
Paper #: 155
How Can Criteria for Interpretation of MRI Examinations
of Appendicitis Influence Diagnostic Accuracy?
Eman E. Marie, M.D.- M.Sc., [email protected];
Ghufran Alhashmi, Angelo Ricci, Carina Man, Andrea Doria,
MD; Diagnostic Imaging, The Hospital For Sick Children,
Etobicoke, Ontario, Canada
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: MRI is an imaging modality that
provides a paradigm shift in the diagnosis of pediatric acute
appendicitis concerning reduced scan time, lack of radiation and
avoidance of intravenous contrast. Our study purpose was to
compare devised MRI criteria for assessment of pediatric
appendicitis with standard criteria.
Methods & Materials: A prospective, IRB approved study,
using a non-sedated ultrafast non-enhanced MRI protocol
consisting of coronal and axial fast spin echo T2 sequences
without fat saturation and axial DWI. Expected maximum scan
time was 10 minutes. MRI studies were reviewed independently
by two radiologists and were graded as: positive, negative or
equivocal for acute appendicitis using devised MRI criteria
(based on retrospective review of confirmed positive cases) vs
standard criteria (reports) as classifiers. Devised criteria for
positive MRI were appendiceal diameter ≥10mm, or
periappendiceal signal intensity (SI) on T2-WI, and presence of
an appendicolith in the presence of other inflammatory signs.
Absence of those criteria was graded as negative. Non-
visualized appendix in the presence of RLQ inflammatory
changes with no alternate cause was graded as equivocal.
Standard criteria for positive test results were appendiceal
diameter >7mm, and the presence of appendiceal intraluminal
fluid, increased periappendiceal SI on T2-WI and the presence
of an appendicolith. Alternate causes of RLQ pain were
recorded if present. Final diagnosis was established by review
of surgical and pathology reports or 1-month clinical follow up.
Results: 350 children (178 girls, 172 boys), 4-18 years old
(mean ± SD age, 9.7±3.5 years old), with clinically suspected
acute appendicitis underwent sonography. 86 patients had
ultrafast non-sedated, non-enhanced MRI studies performed. 73
out of 350 patients had acute appendicitis, 8 were positive on
MRI. Both devised and standard criteria sensitivities were
87.5% (95% CI, 47.3-99.7%); specificities of revised vs
standard criteria of MRI were 97.4 % (95% CI, 91.0-99.7%) vs
83.3% (95% CI, 73.2-90.8%) PPV: 77.8 % (95% CI, 46.5-
93.4%) vs 35.0% (95%CI,15-59.2%); NPV: 98.7% (95% CI,
92.4-99.8%) vs 98.5 % (95% CI, 91.8-100%), respectively.
Conclusions: Specificity and PPV of MRI varied substantially
according to criteria used. Standardization of interpretation
criteria of MRI is urgently required to enable comparison of
diagnostic performance of MRI studies within institutions over
time (upon learning curves) and between institutions for
evidence-based purposes.
Paper #: 156
Walk in My Shoes: Interdepartmental Role Shadowing to
Develop Workplace Wellness at a Large Pediatric Radiology
Department
Tigist Hailu, MPH, [email protected]; Abigail
Ginader, Alessandria Nigro, Dawnisha Lee, Raymond
Sze; Radiology, Children's Hospital of Philadelphia,
Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Poor relationships, oftentimes based
on mere lack of exchange, have a negative impact on employee
wellness. Our nearly 500-member department implemented the
shadowing program “Walk in My Shoes” to improve
interdepartmental relationships and build a stronger sense of
community. The program provides both clinical and non-
clinical employees an opportunity to shadow colleagues in their
various roles and learn more about each other’s contribution to
the overarching mission of caring for children and their
families. This research project aims to understand the impact of
such a shadowing program on employees’ perceptions of
various roles.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S136
Methods & Materials: A preliminary survey distributed to our
department in August 2018 assessed the level of interest in the
program and covered which role(s) participants were interested
in shadowing. Out of 61 employees who completed the
preliminary survey, we selected 30 participants and matched
them to a coworker in their area of interest. The roles for
shadowing included Child Life Specialist, Technologist,
Research Staff, Radiologist, Nurse, Administrator, and
Information Technologist. Participants were required to
complete a pre and post survey to assess their shadowing
experience. Individuals who hosted the shadow experience also
completed a survey.
Results: Since September 2018, 6 Technologists, 5 Researchers,
5 Administrators, and 2 Nurses participated in the program. The
majority of the participants shadowed Radiologists (n=18, 33%)
and Research Staff (n=18, 28%).Participant’s understanding
(44% vs. 61%) and value (50% vs. 78%) of the roles they
shadowed changed after the shadowing experience.
Preconceived notions about each role (39% vs. 39%) did not
change; however, participants’ understanding of how their roles
relate to each other (44% vs. 61%) increased. Participants
showed great interest in shadowing the specific role again
(89%) and shadowing another role (94%).Post-shadowing
survey comments reveal newfound appreciation for
interdepartmental role differences and a heightened sense of
collegiality. Responses from the host survey were especially
enthusiastic. All hosts would repeat the experience (100%).
Conclusions: Our study shows how interdepartmental
shadowing increases a sense of community between clinicians
and non-clinicians, which in turn contributes to the broader
initiative of workplace wellness. The enthusiasm and openness
of the hosts provide evidence that this type of program is
practicable in a large busy department.
Paper #: 157
Assessment of Factors Associated with Burnout and
Wellness in Pediatric Radiologists
Rama Ayyala, MD1, [email protected]; Raymond Sze2,
Brandon P. Brown, MD, MA3, Grayson Baird1, George A.
Taylor4; 1Radiology, Rhode Island Hospital- Hasbro Children's
Hospital, New York, NY, 2Children's Hospital of Philadelphia,
Philadelphia, PA, 3Indiana University School of Medicine,
Indianapolis, IN, 4Boston Children's Hospital, Boston, MA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: An initial survey of Society for
Pediatric Radiology (SPR) members in 2017 showed high
prevalence of burnout in pediatric radiologists. The purpose of
this study is to identify factors associated with burnout to
ultimately guide development of departmental interventions for
alleviating burnout and promoting wellness.
Methods & Materials: SPR members were sent a survey of
questions on institutional factors contributing to burnout, such
as call demands, work environment, departmental support and
administrative/academic tasks. Questions about wellness
resources and mental health were also included. Generalized
linear modeling assuming binomial distribution was used for
analyses with SAS 9.4.
Results: Response rate was 305/1282 (24%), with 53% female.
Most respondents (47%) work at a free standing children’s
hospital. 35% work at a children’s hospital within a large
academic medical center, with 48% of those respondents feeling
less supported than adult divisions. 60% of respondents feel call
is busier than when first started. Frequently performing clinical
or academic work outside of working hours was reported by
64% and 50% respectively. 41% feel they are short-staffed
frequently or always. Respondents reported both number and
complexity of clinical cases have increased since first starting
practice, while the days and hours worked did not change,
p<.0001. Using a scale of 0 (never), 1 (rarely), 2 (sometimes), 3
(frequently), 4 (always), compared to when first practicing,
clinical demands have most notably reduced time for research
(2.5, p<.05). Covering multiple hospitals (2.2) and bureaucratic
tasks (2.4) were the most stressful parts of respondents’ job,
despite reporting a supportive and non-hostile work
environment (2.8, p<.05). For those in administrative roles, job
related tasks decreased satisfaction (2.0) and teaching duties
suffered the most (2.0). 52% of respondents have been affected
by mental illness due to work stresses. 25% of respondents
know a physician who has contemplated or committed suicide.
39% endorsed having resources available to address burnout,
with 33% of those respondents utilizing these resources.
Conclusions: Multiple departmental factors have been
identified as impacting individual’s career perceptions and
overall wellness, which can be potential drivers of burnout in
pediatric radiology. These results can be used to initiate
development of departmental interventions to ultimately
alleviate burnout and promote physician wellness in pediatric
radiology.
Paper #: 158
Gender Representation in Recent SPR-Sponsored Events
Ami Gokli, MD2, [email protected]; Cory M. Pfeifer,
MD1; 1Diagnostic Radiology, University of Texas Southwestern
Medical Center, Dallas, TX, 2Children’s Hospital of
Philadelphia, Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: The gender distribution of physicians
has emerged as a significant policy issue in diagnostic
radiology. While radiology has traditionally experienced female
under-representation, pediatric radiology is a rare subspecialty
in which men and women are represented similarly. Pediatric
radiology is also unique in that approximately half of pediatric
radiologists are affiliated with academic centers which renders
the subspecialty rich with opportunities for teaching, leadership,
and scholarly discovery. This study looks at current trends in
male and female participation in recent educational, leadership,
and research-based SPR-sponsored activities as a means to
define the current state of gender representation within this
subspecialty while developing baseline metrics and goals to
promote a culture of inclusion.
Methods & Materials: A retrospective review of materials
available to SPR members was performed. For the purposes of
this study, male and female genders are defined by the most
common associations of given names in the United States. In
cases where the gender of the individual was in doubt, an
Internet search for pronouns used in the physician's profile
(he/him/she/her) was used to designate gender for the purposes
of this study. Individuals in which determination could not be
made were excluded. The 20 largest children’s hospitals were
defined by using Becker's Hospital Review.
Results: Females are historically under-represented as past
presidents of the SPR, but this trend has reversed in recent
years. 50% of those scheduled to provide oral scientific
presentations at the 2018 SPR Annual Meeting were female, but
women represented only 36% of presenters in the Postgraduate
Course. As of mid-2018, fewer than 5 of the 20 largest
children's hospitals had female radiologists-in-chief. Regarding
the 2018 meeting of the Society of Chiefs of Radiology at
Children's Hospitals (SCORCH) which may host multiple
representatives from a single hospital or include representatives
acting in place of sitting chiefs, 37% were female.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S137
Conclusions: Women remain under-represented in some SPR-
related roles. SCORCH attendance suggests that women are
either more likely to lead smaller pediatric radiology
departments or serve as vice-leaders who are interested in
improving collaboration with pediatric department chairs. To
improve gender diversity, the SPR might consider sponsoring a
"50/50" Postgraduate course in which each lecture topic is split
between a male and female presenter.
Paper #: 159
Review of Learning Opportunity Rates: Correlation with
Radiologist Assignment, Patient Type, and Exam Priority
Marla Sammer, MD1, [email protected]; Marcus
Sammer1, Lane F. Donnelly, MD2; 1Radiology, Texas
Children's, The Woodlands, TX, 2Stanford University, Stanford,
CA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Common cause analysis of exams
actively submitted as learning opportunities in a peer
collaborative improvement (PCI) process can gauge both
opportunities to improve and potential risk to patients. Here,
rates of learning opportunities were evaluated based on
radiologist assignment, patient type, and exam priority.
Methods & Materials: All exams dictated at our pediatric
hospital between July 3, 2016 (first full day 24/7 in-house
attending) and July 31, 2018, were obtained from RIS including
time of dictation, patient type, and exam priority. Exams were
categorized based on radiologist assignment, patient type—
Inpatient (IP), Outpatient (OP), or Emergency (EC), and exam
priority (Stat, Urgent, and Routine). Assignments were defined
by institutional rotations of Evenings (5p–10p), Nights (10p-7a),
and Daytime (7a-5p, analyzed in two groups as Weekdays and
combined Weekends & Holidays). Actively submitted PCI
learning opportunities were identified and categorized. Rates
were calculated by dividing number of learning opportunities by
total number of exams in each category. Chi-square test was
used to analyze rate differences. Pairwise comparisons were
made for rotations and patient types with Bonferroni method
adjusted p-values. Note that the peer learning system studied
here focuses primarily on the professional aspects of radiology,
and is separate from the hospital incident reporting system
which was not evaluated here.
Results: There were 559676 studies. Of these, 1370 were
submitted as learning opportunities (overall rate 0.245%).
Differences in rates by assignment were statistically significant
(p<0.0001) with highest rates on exams dictated Evenings
(285/91290, 0.313%) and lowest on Nights (157/82467,
0.190%). Daytime Weekends & Holidays (99/37441, 0.264%)
and Daytime Weekdays (829/348478, 0.238%) fell in-between.
The differences between Evenings and Nights (p<0.0001) and
Evenings and Weekdays (p<0.001) were significant. There were
significantly higher rates on IP’s (554/169371, 0.327%) than
OP’s (689/312423, 0.221%, p<0.0001) or EC (127/77882,
0.163%, p<0.0001). There were no significant differences based
on exam priority (Stat 428/182463, 0.235%, Urgent 81/31586,
0.256%, and Routine 861/345627, 0.249%, p=0.5431).
Conclusions: In this study, the highest learning opportunity
rates occurred on evenings and inpatient studies. These higher
rates correspond to increased risk and are likely related to both
high volume of studies per radiologist (evening assignment) and
exam complexity (inpatients).
Paper #: 160
Teaching File: An Extensive Revision to Optimize
Integration and Educational Value
Ami Gokli, [email protected]; Tara Savage, Janet R. Reid, MD,
FRCPC; Children's Hospital of Philadelphia, Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Teaching files (TF) are often under-
utilized at institutions for various reasons including inefficient
software programming, poorly designed user interface, or
medical staff resistant to change. We demonstrate how to
repurpose a teaching file in order to bolster user acceptance and
educational value by optimizing TF integration.
Methods & Materials: Using a pre-existing teaching file in the
Primordial® platform which was available but rarely used, we
repurposed the program to improve functionality and user
interface as well as improve ease of use and encourage
integration. We demonstrate an all-encompassing 6 step
approach to curriculum development based on Kern including
identifying the problems, performing a targeted needs
assessment, outlining goals and objectives, providing a vision
for the TF, and listing desired features. Multiple 5-minute
information sessions were implemented at the start of the new
trainee year to reinforce use prior to educational conferences. A
hands-on simulation session for all residents and fellows was
given by an information technologist specializing in radiology
and Primordial®. Finally, we reinforced educational strategies
by requiring the TF to be incorporated into interdisciplinary
conferences given by attendings and fellows.
Results: Our all-encompassing approach was executed to
improve functionality and increase use. Teaching File
integration into the program was successful with a significant
increase in utilization since its implementation. The number of
teaching file entries were recorded at zero in March 2018, and
after implementation of the new TF, teaching file entries
steadily increased (14 - June 2018, 18 – July 2018, 34 – August
2018) with continued upward trajectory.
Conclusions: Through a deliberate and thorough process, a
fully integrated, repurposed Teaching File was created and
successfully integrated into the radiologists’ daily routine.
Radiologists at all training levels now incorporate TF into
lectures, teaching file educational lectures, and interdisciplinary
conferences and catalogue individual cases.
Paper #: 161
Multifaceted Educational Scaffolding Supports Sub-
Specialization in Pediatric Radiology
Ami Gokli, MD, [email protected]; Brian Hopely, Janet
R. Reid, MD, FRCPC; Radiology, Children's Hospital of
Philadelphia, Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Pediatric radiology is a unique
specialty that requires knowledge and skills in all facets of
pediatric imaging including body systems, modalities and ages
from 0-21 years. Mounting pressure exists in larger academic
departments to develop subspecialty service lines in areas such
as MSK, fetal, GI and GU imaging among others. Herein we
describe our approach to developing an educational scaffolding
to support sub-specialization.
Methods & Materials: Our Learning Management System
(LMS) was partitioned to house all relevant materials and tools
for each of 11 subspecialties. An education steering committee
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S138
created breakout groups for each subspecialty to develop and
maintain curricula to include a lecture syllabus, assessment
questions (to contribute to a question bank) and relevant
supportive reference articles. Each subspecialty group collected
relevant tools, seminal articles, graphs and suggested protocols
used to set up and interpret images. Diagnostic toolboxes were
created to house all of the reading tools and references. An
intelligent tutor (IT) was created to push relevant toolboxes to
the PACS for each examination to support subspecialty level
reads. A point of care tool streamlined the creation of “teaching
files” that were sorted by subspecialty, with a plan to link back
to the toolboxes to serve as reference examples. Assessment
included navigation analytics and focus group interview of
residents and fellows.
Results: Eleven subspecialty curricula were created in: chest,
cardiovascular/lymphatic, fetal, GI, GU, MSK, neonatology,
neuroradiology, oncology, emergency, IR. There were 2-25
courses within the curricula (mean 10). Since creation of the
toolboxes, LMS was accessed 6605 times per month, 1272
times for toolboxes, with MSK and GI/GU most popular. The
IT was used mainly in US, MSK, and plain film for
measurements. Focus group of six reported the resources
supported their efforts and increased their confidence in image
interpretation, teaching, and learning. Teaching cases will be
integrated into the LMS and IT in the next iteration.
Conclusions: The drive to subspecialize in pediatric radiology
can be supported through an education initiative that develops a
scaffolding to include relevant up to date reference resources,
instructional materials and reference cases delivered at point of
care.
Paper #: 162
RADIAL Learning Management System - One Year Later
Ami Gokli, MD, Brian Hopely, Janet R. Reid, MD, FRCPC,
[email protected]; Radiology, Children's Hospital of
Philadelphia, Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: RADIAL LMS, a tool to manage and
increase timely access to educational content that tracks
utilization and progress over time, was launched in October
2017 to consolidate valuable resources to enhance radiology
education and the quality of work at the PACS. We present the
utilization and perceived value of this tool one year later.
Methods & Materials: RADIAL LMS was created following a
methodical educational research process that included: needs
assessment; inventory of existing resources; analysis and choice
of best platform; implementation readiness assessment; and
roadmap. A timeline for staged rollout and scalability beyond
our institution was also developed. The LMS was launched Oct
2017 to all radiology trainees and attending radiologists holding
institutional sign-on. Access was also given to administrators,
researchers, assistants and incoming fellows. LMS analytics and
focus group interview of current fellows and residents were
tools used for assessment and evaluation of the LMS including:
Navigation: number and time of access, number of users, top
resources accessed; Rate of development of courses and
curriculum; Appeal: look and feel of user interface, ease of
navigation, preferred resources, drawbacks, and future
directions for improvement and expansion.
Results: Navigation: 178 registered users with 40-79 logins per
day; 1-20 logins per day 2000h-0730h ; 1000 logins per month;
average time per resource 2-4 minutes; top “courses”: toolboxes
and research onboarding. Course Development: 261 courses and
11 curricula; three apps; 51 new objects per month. User
Interface: Appealing and intuitive interface but inconsistencies
with access related to firewall issues at the institution level.
Most helpful for toolboxes, presentation preparation, accessing
papers, on-the-go learning. Future directions: Ongoing program
assessment with seamless integration with PACS. Process
mining using deep learning to generate student modeling
algorithms to drive adaptivity and produce true mastery. Inter-
institutional collaboration to create a universal resource for
pediatric radiology.
Conclusions: RADIAL is a full-service LMS that has gained
traction as a resource used for working, teaching and learning at
point of care and beyond. The largest drawback related to
inconsistencies in access has a manageable solution. It has
future promise as a game-changer to support the breadth of
subspecialty radiology knowledge to maintain mastery-level
image interpretation and promote mastery of the field for
trainees.
Paper #: 163
Cost-Effectiveness Analysis in Pediatric Radiology: How the
Evidence (or, the Lack Thereof) Can Lead Future Research
Hansel J. Otero, MD1, [email protected]; Andrew J.
Degnan, MD, MPhil1, Nadja Kadom, MD3, Peter J. Neumann,
ScD2, Tara A. Lavelle, PhD2; 1Children's Hospital of
Philadelphia, Philadelphia, PA, 2Tufts Medical Center, Boston,
MA, 3Children's Healthcare of Atlanta, Atlanta, GA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To systematically review all
published cost-effectiveness analyses (CEA) of imaging
technologies in children
Methods & Materials: We identified all CEAs involving fetal
and pediatric imaging included in the Tufts Medical Center
CEA registry, a repository of CEAs published since 1976. Two
reviewers with formal training in CEA extracted information
from each article on study methods, costs, quality adjusted life
years (QALYS, a single measure combining quality of life and
survival), quality of life adjustments (i.e., “health utilities”),
incremental cost-effectiveness ratios (ICER, a ratio of
incremental costs relative to the incremental effectiveness of the
new intervention compared to a standard intervention). We
recorded imaging modality, organ system of interest, country of
study, year and journal of publication
Results: Of 480 diagnostic CEAs, 205 investigated imaging and
only 10 focused on fetal and pediatric imaging. The most
common imaging modalities studied were CT (n=5) and
ultrasound (n=5). Four studies evaluated neuroimaging
interventions; while 2 evaluated fetal, 2 other gastrointestinal
tract imaging.The 10 studies reported 43 quality of life
adjustment measurements (health utilities); of which, 20
(46.5%) used previously published adult quality of life
adjustments, 11 (25.6%) were pregnant women perspectives and
12 (27.9%) were treating physician perspectives. No study used
quality of life elicited from children nor took into consideration
postnatal impact of disease on the quality of life of families.Of
37 ICERs generated, 7 (18.9%) were for cost-saving
interventions (i.e., less expensive and more effective than the
comparator) and 6 (16.2%) were for more expensive and less
effective interventions. The remaining ICERs ranged from
$1,400-per-QALY (MRI versus US in newborns with moderate
risk of occult spinal dysraphism) to $10,000,000/QALY (CT
versus no imaging in children at low risk for craniosynostosis).
Using a threshold of $100,000/QALY, 22 (59.5%) of the
imaging interventions were cost-effective.
Conclusions: There is a striking paucity of cost-effectiveness
studies evaluating imaging technologies in children. Moreover,
studies did not incorporate costs from patient and family
perspectives (e.g., loss wages, travel, time off) nor utilities (e.g.,
impact of child’s disease on families’ quality of life). Our
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S139
results indicate a need for more research on the impact of
disease on families and an increased understanding of the cost-
effectiveness of pediatric imaging interventions.
Paper #: 164
Tackling the “black hole” of encounter specific quality
improvement data in imaging
Erin L. Mesi, RT(R), [email protected];
Rajesh Krishnamurthy, Nicholas A. Zumberge, MD, Benjamin
P. Thompson, Courtney M. Kirby, MBA, Phillip McGonagill,
BA, Lean Six Sigma Black Belt; Nationwide Children's
Hospital, Columbus, OH
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To foster a global quality culture,
many hospitals deployed informatics and organizational
solutions, including daily readiness huddles to track department
operational issues, reporting systems to track enterprise wide
safety and near-miss events, and statistical process measures for
quality improvement. Radiology visits have a unique daily
workflow encompassing Planning, Acquisition, Post-processing,
Interpretation, and Communication (PAPIC). Current radiology
information systems (RIS) do not capture opportunities for
improvement in the above spheres, which are patient encounter-
specific. Therefore, error detection and reporting is unreliable.
Capturing this detail is critical in identifying and tackling
improvement projects that have direct impact on patient care.
Methods & Materials: In the radiology department of a large
pediatric center, we created an informatics solution called
OPEN (Ongoing Professional Evaluation) within RIS to allow
quick 15-30 second capture of real-time encounter-specific
opportunities for improvement. Input is categorized based upon
imaging workflow (PAPIC), with a free-text comment box for
radiology experts to describe issues. Clinical specific data is
automatically captured in the hospital information system (HIS).
The imaging quality team further augments data collection by
categorizing into granular quality elements to evaluate for
themes and improvement opportunities, which are then
communicated by weekly reports to section leadership for
resolution. The collected information is deemed confidential
and privileged peer review data.
Results: This new mechanism was envisioned in 2017, built and
implemented in the summer of 2018, with staff training and
education prior to launch. Engagement and trends are being
tracked and evaluated from July-Oct 2018. A total of 385 entries
have been reported in OPEN. Of the 385 recorded entries, the
largest category was acquisition issues (51%). Acquisition
issues include subcategories such as artifacts, motion,
technique, wrong exam, equipment errors and missing
information. The second largest category was planning. This
commonly included issues obtaining correct orders or protocols
which lead to delay in patient care.
Conclusions: OPEN is created as a non-punitive, user friendly,
quality reporting tool in radiology. It seamlessly integrates with
RIS/HIS to provide automatic contextual information, and
causes little disruption to patient care, thereby promoting
engagement and insight into opportunities for improvement in
imaging.
Paper #: 165
Comparison of Different Weight Groups in Pediatric
Trauma Using Split-bolus Single-pass Contrast CT
protocol.
Martin Koci1, [email protected]; Tomas Melis, Dr1,
Martin Willemink, Dr2; 1Radiology, Motol University Hospital,
Prague, Prague, Czechia, 2Stanford School of Medicine,
Stanford, CA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: The Royal College of Radiologists
(RCR) recommends a split-bolus single-pass CT-protocol for
evaluation of pediatric trauma. We assessed the feasibility and
enhancement achieved in different patient weight groups.
Methods & Materials: We retrospectively included 117
pediatric trauma-patients who underwent a split-bolus single-
pass trauma-CT between August 2015 and August 2018.
Contrast-enhancement was measured in the aorta, portal vein,
pulmonary trunk, spleen, liver and pancreas. Attenuation,
contrast-to-noise ratios (CNR) and subjective evaluation of
spleen-enhancement homogeneity were compared among five
weight groups with 15 kg increments (W1-W5, respectively).
Results: Median aortic attenuation was significantly higher
(p<0.05 ) in low weight-groups of 0-15kg (493[315-583]
Hounsfield units (HU)) and 16-30kg (296[238-345] HU)
compared to the high weight-groups of 31-45kg (242[218-310]
HU), 46-60kg (182[151-248] HU) and >61kg (199[151-223]
HU). Similar results were found for portal vein and pulmonary
trunk. Optimal enhancement levels (as reported in the literature)
were not achieved in 23% of aortas, 38% of livers, 40% of
pancreases. Spleen inhomogeneity was observed in 34%; 26%;
21%; 5%; 13% (W1-W5) of cases (p=0.005), respectively.
Despite similar noise-levels (p=0.38, CNR was significantly
higher (p<0.05) in low weight-groups (W1 15.1; W2 11.1)
compared to high weight-groups (W3 9.8; W4 6.7; W5 6.0).
Conclusions: Evaluation of the RCR-adapted pediatric trauma
protocol showed relatively poor vascular and solid-organ-
enhancement in the highest weight-group and high vascular-
enhancement in the lowest weight-group. Spleen-homogeneity
and solid-organ-enhancement were insufficient in a substantial
number of cases, mainly in higher weight groups. Our study
indicates that tailoring unified protocol for different weight
groups is challanging and further refining of the split-bolus
single-pass CT protocol for children is essential.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S140
SCIENTIFIC PAPERS -
TECHNOLOGISTS (T) indicates an Imaging Technologist Program Submission
Paper #: 001 (T)
Upper gastrointestinal studies indeterminate for
malrotation: Are there opportunities for improvement?
Theresa Moore, RT, [email protected]; Lauren W.
Averill, MD, Leslie Grissom, MD, Kathleen Schenker,
MD; Medical Imaging, Nemours AI duPont Hospital for
Children, Wilmington, DE
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: A number of upper gastrointestinal
(UGI) studies were performed at our institution and interpreted
as indeterminate for UGI rotation. These indeterminate cases led
to family anxiety and provider uncertainty about the best course
of action. We undertook a retrospective case review of all UGI
studies performed over a 1 year period as part of a quality
improvement initiative. The purpose was to identity the
percentage of indeterminate UGI cases and any opportunities
for improvement in imaging technique that could reduce this
rate.
Methods & Materials: All upper UGI studies from June 2017
to May 2018 were identified using the electronic medical
record. All cases were categorized as normal, abnormal, or
indeterminate rotation. All indeterminate studies were reviewed
by a board certified pediatric radiologist using a list of criteria
for optimal UGI technique:1. Avoid over distension of the
stomach with air or barium2. With true lateral position,
document the retroperitoneal position of the 2nd and 4th portions
of duodenum3. Use an unrotated AP view to document the
duodenal jejunal junction (DJJ) to the left of the left pedicle of
the spine, and at the level of the duodenal bulb4. If there is
uncertainty regarding position of the DJJ, follow the barium to
cecum or consider contrast enema.
Results: 514 UGI studies were performed over the 1 year
period, with 24 dictated as indeterminate for UGI rotation. 6
were excluded because the duodenum did not fill with contrast
(2 pyloric stenosis, 2 refusal to drink, 1 small bowel follow-
through, 1 duodenal web). The remaining 18 cases (3.5%) were
all indeterminate because of low position of the DJJ. With
radiologist review for imaging technique, no technical issue was
identified in 5/18 cases. Patient rotation in the AP projection
(7/18) and/or lateral projection (4/18) was the most common
technical factor. Overdistension of the stomach was seen in 4,
and duodenal sweep was poorly seen in 2 cases. Contrast was
followed to the colon in 4 cases, with normal position of the
cecum in 1, abnormal position in 2, and poor visualization in 1.
Conclusions: Over a 1 year period, 3.5% of UGI studies were
indeterminate for UGI rotation. Patient rotation was the most
common factor that may have contributed to indeterminate
impression. To help reduce this rate, future intervention will
focus on the radiologist and technolgist working cooperatively
to acheive optimal patient positioning and technique using a
verbal checklist.
Paper #: 002 (T)
The Importance of Proper Patient Positioning and
Immobilization in Suspected Non-Accidental Trauma Cases
Roxanne Munyon, BA, [email protected]; Merima
Karastanovic, Gina Fanelli, Dawn Whitson, Martha Saker;
Radiology, Lurie Children's , Chicago, IL
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: The purpose of this study is to
educate on the importance of proper patient positioning and
immobilization techniques for the X-ray technologist while
performing suspected non-accidental trauma cases. It will
further explain the types of fractures that are typically seen in
these cases and the subtlety of such fractures.
Methods & Materials: Non identified case studies, discussion
of immobilization devices and discussion of vulnerable
population will be utilized. Comparisons of confirmed cases of
non-accidental trauma (abuse) to cases where abuse was ruled
out. Explanation of techniques technologists can use to properly
immobilize patients along with helpful positioning aids.
Photographs of these devices will be provided.
Results: Proper immobilization and positioning skills help to
improve the diagnosis of non-accidental trauma cases. This
allows those children that are most vulnerable to receive the
medical care and social work intervention that they require.
Conclusions: When patients are immobilized correctly and
optimal positioning is utilized the best images possible can be
reviewed by Radiologists. The Radiologists are given the best
opportunity to detect very subtle fractures that are often present
in non-accidental trauma cases. Proper diagnosis of non-
accidental trauma allows for child welfare agencies to utilize
protocols to get these children proper care.
Paper #: 003 (T)
Running a Hospital in-house3d printing lab: Challenges and
Considerations
Elizabeth Silvestro, MSE, [email protected]; Michael
L. Francavilla, MD, Raymond Sze; Radiology, Children's
Hospital of Philadelphia, Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: The Children’s Hospital of
Philadelphia first started additive manufacturing i.e. 3D printing
in 2012 and has since renamed its laboratory to the Children’s
Hospital Additive Manufacture for Pediatrics (CHAMP 3D).
CHAMP 3D focuses on the use of 3D printing in surgical
planning, educational training, and research. The following
provides some operative insights into CHAMP 3D and some
tips on starting an AM/3D lab.
Methods & Materials: Setup & LocationDetermining setup
and location is a crucial starting point. An in-house lab allows
for convenient collaboration within direct workflow of many
groups, but this convenience also comes at a cost. The
involvement of building operations is essential to ensure space
is feasible.Goals & MachinePrinter selection is interlocked with
the lab’s goals and can set limitations on project scope. The first
steps in establishing a 3D lab would be to outline the ideal set of
projects and find a machine to match, taking into consideration
examining material, cost, applications, and space
availability.Team & CollaborationsIt is important to have a
dedicated team of radiologists, engineers, administrators, and
technologists. Each plays a key role in running the lab,
brainstorming projects, segmenting scans, and expanding
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S141
opportunities.Cost CenterThe CHAMP lab has introduced an
internal billing model. Departments are charged for their prints
based on a combination of material used, time processed, and
flat overhead rate. The overhead rate has the dual purpose of
recouping the cost of running the lab and limiting frivolous
printing.OutreachOutreach can greatly extend the possibilities
of the lab, ranging from collaboration to education and even
recruitment of new team members. Collaborations with AM/3D
labs can be an excellent opportunity for resource and knowledge
sharing. Education and Maker events provide networking and
discussion on the newest methods. Internship for students can
expand the team and promote interest in additive manufacturing.
Results: In the last year alone, the CHAMP 3D Lab has
supported over twenty-five different groups across the hospital
and university. A new metric of success targeting papers,
intellectual property, and grants (PIG) has been introduced to
drive the focus of the lab and project.
Conclusions: Hospitals around the world continue to establish
additive manufacturing labs for research and clinical
applications at an ever increasing rate. Strong planning
techniques can greatly improve the effectiveness and success of
the lab.
Paper #: 004 (T)
Application of 3D Printing and Mold Making to construct
custom Phantoms and Task Trainers
Elizabeth Silvestro, MSE, [email protected]; Michael
L. Francavilla, MD, Raymond Sze; Radiology, Children's
Hospital of Philadelphia, Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Phantoms and task trainers are
utilized in a variety of training and education purposes. Hands-
ontraining with realistic tools allowsfor a controlled learning
setting and practice. Unfortunately, these phantoms and trainers
can have prohibitive costs and tend to lack pediatric options.
The growth of additive manufacturing (3D printing) and other
fabrication methods can be used to create pediatric trainers to
meet these educational needs unavailable on the market.
Methods & Materials: Additive manufacturing and other
fabrication methods, such as silicon molding, are beneficial
tools when designing and creating custom phantoms and
trainers. Additive manufacturing models can be printed in
various types of plastic, rubber, powder, or metal to create a
phantom. It can also be used to print molds for silicon pours,
therefore allowing for detailed forming. Silicon ranges in a
variety of softness, durability, and other certified properties. The
design for these models can be generated from a combination of
scans that can be generalized and anatomized. By referencing
the scans, models can be very realistic in detail. In addition,
features can be added to facilitate the use of the models.
Results: Through experiments with designing phantoms, a few
tips have been developed to accomplish a variety of effects.
First is the use of printed models for embedded structures. A
printed bone structure can be encased in soft silicone to give a
realistic feel and visualization on imaging. The embedded parts
can also be painted to alter the exogeneity. Additives, such as
sand or Metamucil, can be mixed into silicon to alter the texture
and exogeneity, creating varied regions in scans.Internal cavities
can be a challenge when molding but are essential in medical
trainers. Break molding and dissolvable materials allow for
these cavities to be as detailed as external surfaces. Both
processes start by embedding printed cavities and pathways in
poured silicon. In break molding, the internal parts are forcibly
cracked then pulled and/or poured out. Materials, like PVA, can
be used and washed away to clear the cavities.
Conclusions: Additive manufacturing and silicone molding
open up new opportunities to design custom phantoms and task
trainers to support education and research. Fabrication can be
done with simplicity and can greatly improve understanding in
education and training.
Paper #: 005 (T)
Innovating Change in Imaging for Patient Care
Georgiena Prevett, Master's,[email protected]; CT,
Ann & Robert Lurie Children's Hospital, Chicago, IL
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: The purpose of this case is to analyze
three main components for MR Appendicitis and MR Brain
Ventricles. The first component is to evaluate the reduction of
radiation dosage by changing the exams from CT to MRI. The
second component is to evaluate the reduction of need for
general anesthesia and/sedation. The third and final component
is to evaluate the reduction of the overall cost.
Methods & Materials: The research is being conducted by
utilizing two types of reporting systems EPIC and mPower. Our
time frame for MR Appendicitis is from 3/10/2015- 10/27/2018
and MR Brain Ventricles is from 04/27/2016-10/27/216. Within
these time frames we are evaluating three main aspects;
reduction of general anesthesia/sedation, reduction of cost and
reduction of radiation. Our evaluation is taking the information
within the timeframe that has been determined to evaluate the
three components and calculate the end results.
Results: 1. Reduction in overall costa. Cost analysis of MR vs
CT examsb. Cost analysis of CT contrast and materials2.
Reductions in General Anesthesia/Sedation medicationsa. Cost
analysis of GA/Seditions vs savings3. Reduction in Radiation
Dosagea. Analyzing the estimated reduction of radiation dosage
altering the modality to MR
Conclusions: Our evaluation on the improvement of Patient
Care has enhanced by utilizing altering imaging methods. This
is a substantial change in medical imaging that has been
developing over time to have a positive impact on patient care.
As we look at our statistical results it will conclusively show
that the reduction in radiation dose has increase as well as the
cost savings to the patient and the organization. It also will be
able to prove that decreased need of general anesthesia/sedation
that gives patients the ability to continue their health plan faster
and less stressful.
Paper #: 006 (T)
Staff Engagement and the Correlation with Increasing
Customer Service
Melissa Goehner, [email protected]; Nikki Butler,
BMSc, RT(R)(QM); Diagnostic Radiology, Children's
Healthcare of Atlanta, Stone Mountain, GA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To identify that engaging staff to be
invested in the workplace and the importance of the work being
done will increase the customer service initiatives and develop a
more satisfied patient population.
Methods & Materials: There have been many changes
implemented to increase staff engagement including changing
from 8 hour shifts to 12 hour shifts across all modalities,
bringing all modalities to full staff, new phone technology to
include texting options throughout the hospital, including staff
in decision making, parties and events( some competitive),
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S142
leadership rounding and increased communication, staff projects
and committees for staff to work together, regular leader
meetings, Thank you cards, Dance cards to show patients who
have multiple tests in multiple modalities which exams are first
and to make sure that all tests are completed prior to leaving the
facility, lunch and learns to educate staff and build relationships
with the radiologists and administrative staff.
Results: There was a boost in May of 2018 to focus on
improving customer service. When improving staff engagement
initiatives, customer service scores have been on a slow and
steady increase since utilizing the methods and materials. There
has been a 3% increase in the departmental customer service
scores within the past five months. If staff engagement efforts
continue, a steady increase in scores is expected.
Conclusions: When staff are engaged in the work they do and
invested in the facility, and believe that the organization is
invested in staff, it results in customer satisfaction.
Paper #: 007 (T)
Regulartory Readiness: Preparing Diaganostic Imaging for
Joint Commission Accreditation
Rozalon M. Shipp RT(R)MR), [email protected];
Mary Freeman, Terry Blancq; Diagnostic Imaging, St. Jude
Children's Research Hospital, Memphis, TN
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: As our institutional technology and
standards of care continuously evolve, it is imperative the staff
be informed of the institutional and departmental Policies and
Procedures. Our objective today is to demonstrate the tools and
resources provided to our staff. By utilizing these tools daily,
we ensure patient safety, provide quality of care throughout the
institution and maintain compliance with The Joint Commission
standards for accreditation.
Methods & Materials: This presentation will display
communications throughout the institutions intranet. The
hospitals intranet provides access to the entire campus to new
and updated policies, information on regulatory readiness,
missions and goals. Our Departmental Share Point site provides
our Diagnostic Imaging staff with a Quality Improvement
Dashboard, The Joint Commission updates, Diagnostic Imaging
Policies and Procedures and Regulatory Readiness information.
Results: To evaluate the effectiveness of the 8 months
regulatory readiness initiative we developed and distributed a
survey to Diagnostic Imaging clinical staff. The department
consist of technologists, medical physicists, administrative
director, radiologists, and biomedical service engineers. The
components of the survey consisted of 20 questions covering:
medication management 84.61%, patient rights 92.31%,
infection control 94.23%, and environment of care 86.54%,
medical records 96.15%, and radiology services 94.23%, with
an overall score of 94.34%. Based on the results from the
survey, the department was confident that the clinical staff was
properly prepared for the upcoming Joint Commission Survey.
Conclusions: Upon completion of The Joint Commission
survey, the Diagnostic Imaging Department was 100%
compliant with the mission of the Joint Commission
Accreditation process and the institutional goals. By using the
hospital intranet and department Share Point sites, we are
continuously staying current with updated Policies and
Procedures. All of this again, is to improve the Safety and
Quality of Care for our patients, families and related services.
Paper #: 008 (T)
MR Imaging of the Forgotten Circulation: Intrahepatic
Dynamic Contrast MR Lymphangiography (IH-DCMRL) to
Evaluate the Liver and Central Lymphatics
Justine Wilson, BS, [email protected]; Yoav Dori, MD,
PhD, Christopher L. Smith, MD, PhD, George Englehardt,
Brazinski Brian, Mallory Mueller, Dana Allen, Hoffacker
Shaun, David M. Biko, MD; Radiology, The Children's Hospital
of Philadelphia, Philadelphia, PA
Disclosures: David M. Biko, MD: Financial Interest: Wolters
Kluwer - Royalty: Editor of Review Book. All other authors
have disclosed no financial interests, arrangements or
affiliations in the context of this activity.
Purpose or Case Report: Dynamic contrast enhanced MR
lymphangiography (DCMRL) is a described technique of
dynamically imaging the central lymphatics following
intranodal gadolinium contrast injection. Intrahepatic dynamic
contrast enhanced MR lymphangiography (IH-DCMRL) is a
new technique which visualizes the central lymphatics via the
liver lymphatics. This technique can be advantageous in
evaluating pathology and central lymphatic pathways that may
be unable to be seen from an intranodal approach, including
protein losing enteropathy (PLE) and chylous ascites. We aim to
describe the technical aspects of IH-DCMRL.
Methods & Materials: IH-DCMRL involves ultrasound guided
injection of a gadolinium contrast agent into the intrahepatic
lymphatic ducts followed by MRI of the chest and abdomen
with dynamic time resolved imaging. Initially a 25 gauge 3.5
inch spinal needle is placed intrahepatically adjacent to a branch
of the portal vein under ultrasound guidance. Needle position is
confirmed with fluoroscopy. The patient is then transferred to
the MRI suite. Following a heavily weighted 3D T2 weighted
sequence, gadolinium is slowly injected into the liver
lymphatics and dynamic T1 weighted MR imaging is performed
every 5-20 seconds over 6-7 minutes. This is followed by a high
resolution respiratory navigated 3D IR inherent gradient echo
sequence.
Results: MRI assessment during gadolinium injection of the
intrahepatic lymphatics, can be successful technique for
evaluation of the liver lymphatics, thoracic duct, and to
visualize bowel perfusion as seen in PLE and peritoneal
perfusion as seen in chylous ascites.
Conclusions: IH-DCMRL is a promising cross-sectional
imaging technique to evaluate liver lymphatic flow and can be
helpful for assessment of certain conditions involving abnormal
liver lymphatic flow.
Paper #: 009 (T)
Move over wearable and embedded devices there a new
MRI safety challenge today call ingestible
Maggie Johnson, RT (R) (MR), [email protected]; Radiology, Children’s
National Medical Center, District of Coloumbia, WA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Over the years, the ingestible
electronic pill has been shown to be a clinically relevant
technology platform, with biomedical applications such as drug
delivery, temperature measurements, gastric emptying and
transit times. At the same time there is work being done on the
next generation of ingestible devices such as those powered by
stomach acid or the Capsule Ultrasound device.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S143
Methods & Materials: devices such as those powered by
stomach acid or the Capsule Ultrasound device by Arbabian
LabThe increase usage of the ingestible devices such as the
PillCam, and Smartpill poses a challenge for us in MRI.Families
currently have a hard time recognizing or identifying implanted
devices but seem to be more challenge with identifying or
recognize ingestible devices during our screening process.Most
MRI screening process consist of a screening form and or
interviewing process that has been designed to detect devices
that are either wearables or embedded in the patientsWith the
increase use and development of new ingestible devices, we
must look at our current screening forms and interviewing
process.
Results: When scripting our interviewing process we try using
questions that will help trigger for surgical and or wearable
devices.As we all know the pressures of getting a diagnosis, as
well as being a poor historian can sometimes interfere with how
families respond to questions about devices but the connection
between an ingestible device that is associated with the word
pill becomes even more challenging.We need to continually
change our MRI screening and interviewing processes with
advancements in technology that can have an effect on being
safe in the MRI environmentTo try and meet this challenge we
had discussions with MR safety leaders, and decided on the
following changes;Added the following change to our screening
form, Ingestible(PillCam, SmartPill, etc.) with a Yes or No
check boxScreening interviewing process,added these trigger
questions;1. Do you or your child have anything in them that he
or she was not born with?2. Have you or your child swallowed
any devices for medical use?3. Have you or you chld been seen
in the Gastro-Interstinal Clinic?
Conclusions: Recent advancement in ingestible devices and
advances for next generation devices has become a challenge to
us in identifying ingestible devices. Changes in technology
bring changes to the MRI safety screening process. Continual
updates to both safety screening forms and the interviewing
process should be reviewed as new devices are identified
Paper #: 010 (T)
MRI Safety and the MRSO
Robert Carson, B.S.R.T. R,MR,[email protected]; The
Children's Hospital of Philadelphia, Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: The goal of my talk is to present my
audience with the obstacles that I faced as an MRSO when
implimenting and executing new safety guidlines. I will also
outline the safety team and explain their roles in our safety
council. I will describe how we changed the over all culture in
our department with the help of certain tools to accomplish our
safety benchmarks.
Methods & Materials: I will describe the process of
implimentation of rules and guidlines that we crrenttly use in
our MRI safety process. Show the steps which were taken to
update and improve our MRI safety culture.
Results: Explain how our safety process is better know thatn it
was two years ago.
Conclusions: MRI safety is a on going process that will
constsantly change as a department grows in size and as its
patient numbers increase. With that being said the rules and
guidelines must change as well.
Paper #: 011 (T)
MRI Safety: Getting the FTEs You Need
Trista Maule, RT (R)(CT)(MR), [email protected];
Nikki Butler, BMSc, RT(R)(QM); MRI, Childrens Healthcare
of Atlanta, Acworth, GA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Purpose: To document and present
data to support the need for additional FTEs to ensure a safe
MRI environment.
Methods & Materials: Methods:1. Have a MRI department
safety audit performed by a third party.2. Document all
accidents, near misses or situations that have the potential to
cause harm in a tracking system.3. Compare department staffing
to the ACR guidelines.4. Compare patient volume to the number
of safety incidents. Note any upward trend.5. Financials-
Estimate the cost for the additional staffing. Look into the
possibility of extending hours or adding additional exams to
help offset the cost.6. Compare your institution’s staffing model
with similar institutions.7. Create a presentation for the
organization using the data to show the cost and need to make
your institution compliant with MRI safety.
Results: Results: Additional FTEs granted that allow the
institution to meet ACR standards and decrease the number of
MRI safety related incidents.
Conclusions: With proper data collection and documentation,
gettig the FTEs you need for MRI safety is possible.
Paper #: 012 (T)
Ultrasound Imaging of Orthopedic Magnetically controlled
Spinal Rods
Monique Riemann, [email protected]; Smita
Bailey, MD, Craig Barnes, MD; Radiology Research, Phoenix
Children's Hospital, Phoenix, AZ
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: One treatment for congenital
scoliosis is the use of spine-straightening rods. Previously, the
rods that have been surgically implanted were non magnetic and
required the patient to undergo additional surgeries (usually
every 6 months) to extend the rod length as well as radiographs
pre and post surgical to evaluate the distraction. Currently many
of the rods in use at our institution
are MAGnetic Expansion Control (MAGEC®) rods that can be
extended magnetically with the use of an external remote
controller, thereby no longer requiring repeated surgeries every
6 months. As a result, patients have distractions performed
every other month. While this is a marvelous improvement,
these patients are now receiving an increased number of
radiographs to confirm lengthening and interval correction of
their condition due to the ability to distract every other month
versus every 6 months with non magnetic rods. Several studies
investigated whether ultrasound could be used as an alternative
to X-ray when measuring rod lengthening in order to reduce
radiation exposure. The result showed that ultrasound correlated
very well with X-ray measurements and that while X-ray would
still be needed, ultrasound could be utilized to eliminate the
number of X-rays done and thereby significantly reduce
radiation exposure to the patient. We were asked by the
orthopedic department to see if we could institute a protocol for
ultrasound imaging at our institution for these patients based on
Cheung’s study. What began as a QI initiative has evolved into
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S144
an imaging clinic for these patients. We will show that the
implemented standardized protocol and imaging clinic reduced
unnecessary radiation, improved time management and
increased the quality of care these patients receive. We intend to
share the knowledge we have acquired of this successful
learning model with other facilities around the country.
Methods & Materials: This study will look at the development
of this clinic and evaluate its progression to include the length
of exam times and the amount of radiation exposure between
the standard x-ray method and the newer ultrasound method.
Results: Our imaging clinic resulted in an 83% reduction in
radiation and a 64% reduction in wait time to our patients.
Paper #: 013 (T)
Fabrication and utilization of an Ultrasound Phantom for
young patient engagement and understanding
Elizabeth Silvestro, MSE, [email protected]; Casey L.
Gregory, BS, RDMS, Marcy L. Hutchinson, AS, Jenelle L.
Gardler, BS, RDMS, Suzanne E. DeBari, RDMS, RVT, RT;
Radiology, Children's Hospital of Philadelphia, Philadelphia,
PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Ultrasound equipment and
transducers can be intimidating to young patients. Many videos
and graphics have been made for education, but can be
perceived as disconnected from the clinical process. To help
address these fears and engage collaboration between
sonographers and their patients, a phantom was designed for
children to play and learn before their own scan. This phantom
would need to be pediatric-friendly, simple use, and
educational.
Methods & Materials: The first step was to design an
engaging, approachable figure that children would be interested
in scanning. The CAD program SolidWorks was used to design
a stout, one eye, spiked “monster.” A mold frame was printed
on a Fortus 450mc in ABS plastic. The embedded parts to be
hidden inside the monster's belly included a crown, a heart, a
cat, and a duck; Selected due to their simple shapes that children
of all ages and backgrounds should recognize. These shapes
were printed on a Connex 500 in VeroWhite plastic.The
“monster” was molded out of silicon in a layering process. The
silicon can be dyed any color as desired. The initial 0.5 inch-
layer of silicon was poured. Once set, the shapes were placed
perpendicularly in a pattern within the belly region. A 1.5-inch
layer of silicon was poured on, covering the shapes. A fabric
face was added and the final 0.5-inch layer was poured on top.
Once dry, the “monster” was pushed out of the frame and
cleaned up.
Results: Five sonographers were able to scan and find the
various shapes using curved array C9-2 MHz and linear array
12-4 MHz transducers under pediatric abdominal and superficial
presets. The technologists were challenged and successfully
figured out most of the shapes. Notably the cat shape showed
some challenge with approximately three misidentifications.
The “monster” phantom has since been used as part of the
Ultrasound Awareness Day in our institution, as well as in our
pediatric ultrasound department. In the clinical setting, this
“monster” can be used prior to an exam and allows the pediatric
patient to work with sonographers to understand the procedure
and potentially help to calm their fears.
Conclusions: In summary, this pediatric-friendly “monster”
phantom has been used in our institution to educate children and
offers an excellent opportunity for engagement between the
sonographer and the patient. The next step will be to work with
the child life department to run a larger scale study evaluation of
the “monster” phantoms and the potential benefits to pediatric
patients.
Paper #: 014 (T)
Design and construction of an infant phantom for hip
ultrasound education and training
Elizabeth Silvestro, MSE, [email protected]; Lamont
Hill, BS RT(R), RDMS, Mark Boguslavsky, Glenn Bloom, AS,
RDMS, Michael L. Francavilla, MD, Raymond Sze; Radiology,
Children's Hospital of Philadelphia, Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Ultrasound scanning of infant'ship
can prove to be a challenge to learn for some sonographer from
the precise angling of bones and handling of the not so
understanding babies. Phantoms proved a calmer situation to
learn and practice skills. To this end, an infant hip phantom with
ultrasound visible fat, bones, and femoral head was created. The
model will also need to simulate the physical aspect of the scan
such as the motion and positioning of the hip and bones.
Methods & Materials: The fabrication of the hip started with
the selection of sample patient scan. For this, it was determined
to focus on 3-6-month-old patient with pelvis or adnominal CT
scans with normal bone structures. The bones and body (skin
and contains) were segmented out using Materialise Mimics. A
mold was created with a subtraction of the body and pouring
hole added. Posting was added to the bones to suspend within
the mold and handle extension were placed to the end of the
femur to represent the leg. The femoral head was designed
geometrically and aligned it to the femur.The bones were
printed on a Connex 500 in VeroWhite, which most resembled
bone in hand and under ultrasound. The mold and post were
printed on Fortus 450mc ABS plastic. To improve the
echogenicity of the bones, it was determined to paint them with
acrylic paints. The bones with femoral head and posting were
assembled in the box and the skin toned dyed Smooth-on
Ecoflex 10 silicon was poured.
Results: The hip phantom was tested by several technologist
and radiologist. The phantom was placed on the bed and was
treated like a normal patient allowing sonographer to apply gel
and use traditional set up to practice the procedure as if with a
patient. Each user ran through the standard extent angles:
transverse neutral, coronal neutral, transverse adduct, transverse
abduct, coronal flex and coronal posterior lip.The phantom
proved successful in imaging of the spine, pelvic bones and
femoral head under scanning with a little noise seen in the
silicon that was reduced with degassing process during pouring.
Several commented on the realistic feel of manipulating the leg
and the click of the joints. During one test a student technologist
was even instructed in the probe placement and joint extensions.
Conclusions: Moving forward the next steps will be to fully
implement the phantom into the sonographers training and
education. This phantom has lead to additional requests for
other regions of the body, such as lumbar spine and
neuroradiology applications.
Paper #: 015 (T)
Pulmonary Lymphangiectasia (PL) - Diagnosing with
Ultrasound Instead of MRI - A Fresh Perspective.
Trudy Morgan, [email protected]; David M. Biko,
MD, David Saul, Ammie M. White, MD; CHOP, Phila, PA
Disclosures: David M. Biko, MD: Financial Interest: Wolters
Kluwer - Royalty: Editor of Review Book. All other authors
have disclosed no financial interests, arrangements or
affiliations in the context of this activity.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S145
Purpose or Case Report: Purpose: Pulmonary
lymphangiectasia (PL) is an uncommon life threatening
disorder. Dynamic contrast enhanced MR lymphangiography
(DCMRL) is commonly used to diagnose this disorder but it is
invasive and often requires sedation. Recently, high resolution
chest ultrasound of the lung surface has been proposed as not
only less invasive but also as a less stressful and less time
constraining bedside method for diagnosing PL.
Methods & Materials: Materials and Methods: The chest
ultrasound is performed bedside. High and low frequency
transducers used to acquire diagnostic images concentrating on
the pleural space and lung surface. While the patient is in supine
position, grayscale ultrasound images are obtained bilaterally
with the high frequency linear transducer in the anterior and
mid-clavicular chest noting the superior, middle, and inferior
lung surface bilaterally to evaluate for lung surface irregularity
and cystic changes. The final set of images are performed with
the lower frequency curved transducer to evaluate for pleural
effusions.
Results: Results: By selecting the appropriate transducer,
optimizing the image settings, and imaging in the correct plane,
ultrasound can be a noninvasive tool in diagnosing PL by
focusing on the surface of the lung.
Conclusions: Conclusion: Ultrasound is available as a low cost
and noninvasive option imaging modality to evaluate PL.
Although DCMRL has become the standard in evaluating the
lungs of these infants, ultrasound may be an alternative in
diagnosing patients with this disorder. Our hope in the future is
to use ultrasound as a screening tool in patients with suspected
PL. Future plans may include the use of contrast enhanced
ultrasound injected within the lymphatic system to better
delineate the lymphatics on the surface of the lung
Paper #: 016 (T)
IVUS for Venous Compression Syndromes
Ashley Brondell, [email protected]; Anne Gill, MD, C.
Matthew Hawkins, MD; Interventional Radiology, Children’s
Halthcare of Atlanta Egleston, Atlanta, GA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To describe the logistical and
technical aspects of using IVUS (Intra-vascular ultrasound) for
the diagnoses and imaging of venous compression syndromes.
Methods & Materials: Interventional radiology procedures are
utilized to treat venous compression syndromes including May-
Thurner syndrome, Nutcracker syndrome, portal vein stenosis
and SVC stenosis. Traditionally, venograms and endovascular
pressure measurements have been performed to evaluate the
severity of stenosis. Problems arise with accurately evaluating
the stenosis of venous structures on two dimensional images
(i.e. the flattening of the vein from external compression can be
difficult to visualize from one view). In order to better and more
accurately diagnose the severity of the venous compression, an
intravascular ultrasound (IVUS) allows the operator a full 360
degree view of the vessel. An IVUS catheter has an ultrasound
transducer attached to the distal end of the catheter. There are
three sizes of IVUS catheters; each size allows a specific
viewing diameter based on size of catheter. The catheter is
advanced through the area of concern, and the images are
recorded and reviewed on a separate workstation. Individual
screenshots and diameter measurements can be obtained and
saved. If a flow limiting stenosis is present, further treatment
such as angioplasty or stent deployment can be pursued. IVUS
is particularly helpful in these situations because it allows
precise targeting at the area of stenosis as well as post
intervention imaging to evaluate the success of
angioplasty/stenting.
Conclusions: The use of an IVUS catheter is greatly beneficial
in diagnosing, treatment planning, and post-intervention
assessment of venous compression syndromes.
ALTERNATE PAPERS
Alt #: 001
Quality Improvement and Patient-Centered
Communication: Implementation of NICU Teleradiology
Rounds
Susan E. Schmidt1, [email protected]; Joseph Cao1;
Jeannie Kwon1; Kate Louise Mangona1, 1Radiology, UTSW,
Fort Worth, TX, United States
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Current pediatric radiologists provide
daily onsite consultation for two University hospital NICU
facilities (CUH and PHHS) at times set by the NICU care teams
while also reading studies at the main Children's Hospital
(CMC) reading room, a third separate hospital. This required
travel to three separate physical locations throughout the day,
resulting in wasted time and movement energy expenditure.
Additional challenges to the work flow include elimination of
campus shuttle route, sprawling multicenter campus.
Additionally, similar services for clinical staff are requested at
the CMC NICU.
Methods & Materials: The intervention proposed used a cloud
based interactive audio/visual platform to facilitate
communication between the radiology faculty and NICU
treatment teams at their respective off site locations. The
software platform was required to provide reliable, user-
friendly, and seamless interactivity in order to maintain the
same level of service currently provided by onsite consultation.
The intended purpose of the intervention was to reduce travel
time for pediatric radiologists. Analysis of the travel times was
performed and time saved was determined based on pre-
intervention travel durations. The preservation of consultation
quality following intervention was a primary goal. To that end,
the NICU clinical team members as well as pediatric
radiologists were surveyed on subjective and objective measures
of quality.
Results: Travel times were significantly reduced following
implementation of remote consultation at remote NICU facility,
estimated to save a potential 4940 radiologist-hours over a six
month timeframe. 99% of NICU providers responded very
highly to questioning regarding the added value of a
radiologist’s presence at NICU rounds versus NICU rounds
conducted prior to radiology’s presence during daily rounds.
Satisfaction results were positive after implementing
radiologist’s presence on NICU rounds.
Conclusions: Feedback from pediatric radiology faculty and
NICU treatment teams was widely positive following the
implementation of telerounds. We demonstrated the ability to
provide a similar level of quality of communication, ability to
entertain dialogue regarding exams, timeliness of rounds from
both surveyed groups. Survey of pediatric radiologists and
NICU providers both show significant increase in satisfaction
after implementation across all metrics.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S146
Alt #: 002
Development of ventriculoperitoneal shunt catheter
calcifications predicts shunt failure in pediatric patients
M. A. Siddiqui1, Anna Hardy1; Shannon G. Farmakis1, 1St.
Louis University School of Medicine, St. Louis, MO, United
States
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To determine whether the presence
of calcifications found on radiographic shunt series predicts
whether a patient will experience a shunt catheter fracture or
complication.
Methods & Materials: An electronic medical record (EMR)
search was performed at an academic pediatric hospital to
identify patients with shunt series performed from June 1, 2010-
July 31, 2017. When available, additional prior shunt series in
the patients’ picture archiving and communication system
(PACS) folder were included. Patients aged 0-21 years with a
ventriculoperitoneal, ventriculopleural, or ventriculoatrial shunt
and shunt series were included. Pediatric patients with an initial
shunt series obtained at 22 years of age were excluded. 2630
shunt series radiographs in 523 pediatric patients (301 male, 222
female) were reviewed to identify the presence and
development of calcifications around the catheter. 51 patients
were excluded as a result of pre-existing calcifications and/or
shunt fracture (48), absence of shunt (2), or advanced age (1).
Analysis included descriptive statistics, odds ratio, and Chi
square.
Results: Out of 472 patients (473 shunts), 23 of 59 (39%)
shunts developed calcifications and fractured. 37 of 414 shunts
(8.9%) without calcifications fractured. There is a significant
positive association between calcification and fracture (Χ2=
42.09, p<0.01). It is 6.51 times more likely that a fractured
shunt had calcifications compared to a non-fractured shunt
having calcifications. Calcifications appeared within an average
of 9 years 3 months (range of 3-19 years) after shunt insertion.
Shunt fractures occurred within an average of 5 years 2 months
(range of 6 months-9 years 5 months) after the appearance of
calcifications. Nearly all fractures were at or adjacent to the
calcifications. Shunt fractures occurred within an average of 6.5
cm of calcifications (range 0-13.5cm). The neck was the most
common site of fracture (19/23; 82.6%).
Conclusions: Shunt calcification represents a significant risk
for catheter fracture in the pediatric population. Early
intervention or closer interval follow-up may be indicated in
those found to have calcifications.
Alt #: 003
Transient Respiratory Motion with Gadoxetate Disodium
Gadolinium-Based Contrast Material in Children and
Young Adults Undergoing Liver Magnetic Resonance
Imaging
Leah A. Gilligan.1, [email protected], Andrew T.
Trout.1; Christopher G. Anton1; Andrew H. Schapiro1;
Alexander J. Towbin1; Jonathan R. Dillman1, 1Radiology,
Cincinnati Children's Hospital Medical Center, Cincinnati, OH,
United States.
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Gadoxetate disodium, a gadolinium-
based contrast material utilized in hepatobiliary magnetic
resonance imaging (MRI), is associated with transient
respiratory motion artifact during the arterial phase in adults.
The purpose of this study was to determine if the transient
respiratory motion phenomenon is observed in children. Methods & Materials: This retrospective cohort study was
approved by the institutional review board; informed consent
was waived. Patients aged 4-18 years who underwent dynamic
liver MRI with gadoxetate disodium between October 2010 and
January 2018 were identified. 130 exams from 130 patients
were selected for review, including patients imaged awake or
under general anesthesia. Demographic, medical history, and
imaging data were recorded for each patient. Three blinded
reviewers scored respiratory motion artifacts on precontrast,
arterial, portal venous, and late dynamic phase images using a
5-point Likert scale. Analysis of variance (ANOVA) was used
to assess differences in average motion between phases in both
the awake and general anesthesia cohorts; significant results
were further evaluated using Tukey’s multiple comparisons test.
Multivariable linear regression was used to identify significant
predictors of arterial phase motion in awake patients.
Results: 130 patients (65 boys and 65 girls; mean age: 9.8±3.7
years; awake, n=63; general anesthesia, n=67; gadoxetate
disodium dose, 0.05 mmol/kg) were included. The anesthetized
cohort was slightly younger than the awake cohort (8.9±4.0 vs.
10.7±3.1 years; p=0.007). There were significant differences
between phases in average motion scores in the awake cohort
(p<0.0001) but not in the general anesthesia cohort (p=0.051).
In the awake cohort the arterial phase motion score (mean score:
3.52±0.83) was significantly higher than the precontrast (mean
score: 3.14±0.81; p=0.0003), portal venous (mean score:
3.07±0.92; p<0.0001), and late (mean score: 3.05±0.89;
p<0.0001) phase motion scores. Age, sex, body mass index,
presence of ascites, presence of pleural effusion, and total
contrast dose did not significantly predict arterial phase motion
score in the awake cohort.
Conclusions: We observed significantly increased arterial
phase respiratory motion artifacts in awake children undergoing
dynamic liver MRI using gadoxetate disodium, suggesting that
transient respiratory motion artifact does occur in children. A
similar finding was not observed in patients imaged under
general anesthesia, which may suppress this phenomenon.
Alt #: 004
The Use of Intraoperative Doppler in Pediatric Liver
Transplantation: Results of a Survey of SPR Members
Luana A. Stanescu1; Ramesh Iyer1; Shawn Kamps1;
Marguerite1; Andre A. Dick.1; Grace Phillips1, [email protected] , 1 Radiology, University of
Washington, Seattle, WA, United States.
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Liver transplantation is a potentially
lifesaving treatment for pediatric liver failure. While some
elements of perioperative liver transplant Doppler examinations
are routine in most practices, there is no standard protocol
employed across institutions. To date, no large-scale
investigation has been performed to determine best practices
based on a consensus of radiologists who perform pediatric liver
transplant intraoperative Doppler (IOD) examinations. Our goal
is to survey radiologists who perform these studies to better
understand variability amongst institutions in the use of IOD in
pediatric liver transplant patients.
Methods & Materials: With IRB approval, an online survey
was distributed to 1600 members of the Society for Pediatric
Radiology (SPR) via the email list serve. To avoid redundancy
in responses from the same institution, participants were
encouraged to identify one single person from their respective
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S147
institution to respond to the survey. The name of the
participants' institution was also requested to identify
respondents from the same institution. Participants were
excluded if pediatric liver transplantation was not performed at
their institution, as well as if they were trainees.
Results: Of the 1600 survey recipients, 50 (3%) responded to
and completed it, representing 29 of 58 (50%) pediatric liver
transplant centers within the United States. IOD was performed
at 69% of pediatric transplant centers. In centers performing
IOD, 47% performed examinations routinely with every
pediatric liver transplant. The hepatic artery was the vessel most
commonly routinely interrogated (87%), followed by the portal
vein (83%) and hepatic veins (67%), although 50% reported that
the exam protocol depended on the area of clinical concern. The
surgeon and radiologist operated the transducer with relatively
equal frequency. The pediatric radiologist rendered
interpretation in 93% of institutions, although frequently in
conjunction with the surgeon (30%). Surgeon preference (38%)
was identified as the most common barrier to further expansion
of IOD programs, followed by radiologist availability (25%).
47% of respondents deemed IOD "extremely useful" in the
setting of pediatric liver transplantation.
Conclusions: Despite the perceived utility of IOD in pediatric
liver transplantation, there is considerable variability in the use
of this technique. Our results support the notion of a team
approach between surgeons and radiologists in further
expanding the use of IOD in this population.
Alt #: 005
Radiogenomics in Neuroblastoma: Imaging Patterns in
Patients with ALK Mutations
Alexandria J. Holroyd1, [email protected], Lisa
States1, 1 Radiology, Children's Hospital of Philadelphia, Mount
Laurel, NJ, United States
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: We conducted this study to
determine if there is an imaging biomarker associated with ALK
mutations in patients with neuroblastoma(NB). MYCN
oncogene amplification is identified in 20-25% of all NB cases
and portends a poor prognosis. Aberrations of the ALK gene are
also characteristic of the disease. Both are located on the p arm
of the second chromosome, and are usually associated with
aggressive disease and poor prognosis.
Methods & Materials: Data was collected from subjects under
12 years of age diagnosed between July 2008 to February 2018.
Clinical, surgical, pathologic and genomic data were extracted
from the medical record. Imaging reviewed by a single
radiologist included MRI and I123 MIBG scans performed prior
to surgical resection. Recorded imaging findings were site of
primary lesion (adrenal, neck/thoracic apex, thoracic, lumbar
paraspinal, pelvic, midline abdominal retroperitoneal and
metastatic disease to lymph nodes, liver, lung, brain, and
marrow). MIBG avidity and Curie score were recorded.
Inclusion requirements were pathology results from primary
specimen at diagnosis or after induction chemotherapy.
Results: 66 subjects with mean age of 2 years, (59% female and
41% male) found 20% (N=13) were ALK positive. Of these, 6
were deceased with 4/6 also MYCN+. Additional mutations
were present in all 13. 6 were INRGSS stage L2, 5 were stage
M and one was L1. Imaging patterns described as (#ALK
positive/total, %) were as follows: Neck/thoracic apex (4/4,
100%), bilateral adrenal (1/3,33%), multicompartmental (2/17,
28.5%), chest/thorax (2/9,22%), midline abdominal
retroperitoneal (5/19, 26%), liver metastases (2/9, 22%). Curie
scores ranged from 2-27. Of the 6 deceased, 5/6 had additional
mutations, including P53 and TERT mutations. Other mutations
labeled as having unknown significance were also present. Of
all 66 subjects, 86% had other chromosome aberrations.
Conclusions: The strongest association of ALK mutation with a
specific primary site was the combined neck/thoracic apex. The
lack of a specific imaging biomarker may be related to genomic
heterogeneity. Detection of ALK mutations at diagnosis holds
promise for personalized therapy with upfront treatment with
ALK inhibitors combined with chemotherapy, a current open
clinical trial for high risk patients.
CASE REPORT, EDUCATIONAL AND
SCIENTIFIC POSTERS
Authors are listed in the order provided. An author listed in
bold identifies the presenting author.
Poster #: CR-001
Methicillin-resistant staphylococus aureus in Lemierre's
syndrome: a rare cause of a rare syndrome in pediatric
patients
Donald O. Ibe, M.B.B.S, [email protected]; Maria
Navallas Irujo, Michael R. Aquino, MD; Hospital for Sick
Children, Toronto, Ontario, Canada
Disclosures: Michael R. Aquino, MD: Royalty Income:
Elsevier Co-author. All other authors have disclosed no
financial interests, arrangements or affiliations in the context of
this activity.
Purpose or Case Report: Lemierre’s syndrome is an extremely
rare condition characterized by initial oropharyngeal infection
with development of septic thrombophlebitis and subsequently
disseminated septic microemboli. The syndrome remains a
disease of considerable morbidity and mortality. The incidence
is approximately 3.6 cases per 1 million per year. It is
commonly caused by gram-negative Fusobacterium
necrophorum. However, less than a third of cases is brought on
by other anaerobic bacteria. Here we present a rare case of a
Lemierre’s syndrome in a child caused by methicillin-
resistant Staphylococcus aureus (MRSA). A 4-year old male
presented to emergency department with unremitting fever,
progressive painful submandibular swelling concerning for
Ludwig’s angina, vesicular lesions on the skin, and decreased
level of consciousness. The patient was reported to have fallen
onto his chin with resultant lip laceration and tooth avulsion.
Fever and neck swelling developed two days later. Computed
tomography (CT) of the neck revealed findings in keeping with
clinically suspected Ludwig’s angina including: soft tissue gas,
and diffuse fat stranding involving the sublingual, perioral, and
right submandibular spaces with extension to right
sternoclavicular muscle, carotid and jugular vessels. No abscess
was identified but a focal non-occlusive thrombus was seen in
the right internal jugular vein. Additionally, the lung apices
demonstrated multiple patchy densities raising concern for
Lemierre’s syndrome and prompting further evaluation with a
contrast-enhanced chest CT. Chest CT confirmed the diagnosis
demonstrating multiple, variable-sized, randomly distributed
lung nodules with cavitation, and multifocal consolidation
consistent with septic emboli. Blood culture and skin swab of
vesicular lesions were positive for MRSA. On further
discussion, it was revealed that the patient’s father was recently
treated for MRSA abscess. The patient was placed on
intravenous antibiotics (vancomycin, rifampin, meropenem) and
anticoagulants (tinazaparin) with improvements in symptoms
and imaging findings within six weeks post admission.The
learning points include:1) the need to critically evaluate lung
apices and vasculature on neck CT in patients with evidence of
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S148
soft tissue neck/oropharyngeal infection2) despite the rarity of
Lemierre’s syndrome, multiple cases caused by MRSA have
been described.
Poster #: CR-002
Infantile Myofibromatosis: Prenatal and Postnatal Imaging
Features
Ashley Evens1, [email protected]; Ignacio Gonzalez-
Gomez, MD2, Jennifer Neville Kucera, MD2; 1University of
South Florida Morsani College of Medicine, Tampa, FL, 2Johns
Hopkins All Children's Hospital, St. Petersburg, FL
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Infantile myofibromatosis is a rare
condition consisting of benign fibrous tumors typically
deposited in the skin, soft tissues, muscles, bones, and visceral
organs. The entity can be solitary or multicentric. Although
controversial, outcomes are generally worse in cases with
visceral organ involvement. The prognosis is generally
favorable in cases that lack visceral organ involvement, with a
majority of cases showing spontaneous regression. The imaging
findings of infantile myofibromatosis will be illustrated using
both prenatal and postnatal imaging including ultrasound, MRI,
radiography, CT, and bone scintigraphy. We also present gross
specimen and pathology images. Our case involves a 33 week 4
day gestational age male fetus that initially revealed dilated
loops of bowel on ultrasound. Fetal MRI was performed at 34
weeks and 4 days, which demonstrated the dilated loop was
colon in the region of the hepatic flexure. Additionally, multiple
solid-appearing lung masses were noted, which had not been
visualized on ultrasound. Because of concern for a possible
metastatic process, the entire fetus was thoroughly imaged, but
no primary source was found. The differential diagnosis that
was given on the fetal MRI included metastatic disease from the
mother or fetus, infantile myofibromatosis, or infectious
etiology. The mother underwent induction of labor at 35 weeks
4 days, and the baby was born via uncomplicated vaginal
delivery. To exclude transplacental metastases, the mother
underwent dermatologic skin check, mammography,
colonoscopy, and head CT, all of which were negative.
Postnatal radiographs of the baby revealed a focally dilated loop
of bowel, and the patient underwent exploratory laparotomy. In
the OR, nodules were noted on the small bowel serosa resulting
in a bowel obstruction. Chest radiograph and CT also confirmed
the presence of multiple solid lung masses. Bone scintigraphy
was negative. Pathology from one of the bowel nodules
revealed infantile myofibroma. Our patient has not undergone
any therapeutic treatment, and follow up imaging has
demonstrated continued spontaneous regression of the lung
masses. Although infantile myofibromatosis is a rare entity, it is
important to include in the differential diagnosis in a fetus with
multiple solid-appearing lung masses. Throughout the clinical
course of these patients, imaging plays an imperative role in the
assessment of these lesions.
Poster #: CR-003
Peeing Double – A case report of Caudal Duplication
Anna Smyth, [email protected]; Christina Nowik,
Denise Pugash, Daniel Rosenbaum; radiology, BC Children’s
Hospital, Vancouver, British Columbia, Canada
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Caudal duplication syndrome is a
rare entity that involves duplication of various structures arising
from the embryonic cloaca and notochord. This presentation
outlines the case of a 38-year-old G2P1 woman referred to our
institution at 21 weeks gestation for anomalies detected on
antenatal ultrasound. Antenatal ultrasound demonstrated sagittal
duplication of the bladder, duplex phallus, a bifid scrotum and a
horseshoe kidney. A subsequent fetal MRI confirmed those
findings and also demonstrated apparent duplication of the
colon and dysmorphic lumbosacral spine. Following delivery,
the baby passed urine via both urethras and meconium via a
right-sided anus; there was a left-sided anal dimple with an
imperforate anus. VCUG showed no communication between
the two bladders. A colovesical fistula was demonstrated
between the left bladder and colon, which is likely the
redundant duplicated colon with the imperforate anus. MRI of
the abdomen and pelvis showed a lipomeningocele with
attempted sacral duplication, redemonstrated duplication of the
pelvic organs, and confirmed absence of a left-sided rectum and
sphincteric complex. Caudal duplication syndrome is a complex
malformation, the management of which often requires a
multidisciplinary approach involving radiology, general surgery,
urology, and neurosurgery. This case illustrates the findings of
this rare entity with good correlation between fetal and postnatal
imaging. It also highlights respective contributions of the
various imaging modalities in guiding management, which
usually entails staged surgical correction.
Poster #: CR-004
Systemic Juvenile Xanthogranuloma: A Case Report
Involving the Liver
Malik A. Dawoud, MBBS, [email protected]; Robert
F. Buchmann, D.O.; Arkansas Children's Hospital, Little Rock,
AR
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: We report a case of systemic juvenile
xanthogranuloma affecting the liver in an 18 month old male.
Methods & Materials: The patient’s electronic medical record
was reviewed including clinical notes, laboratory data, surgical
pathology and treatment. Diagnostic imaging studies reviewed
include plain-films, CT, US and MRI.
Results: A previously healthy 18 month old male presented to
the emergency department with congestion, fever and
abdominal distention. Abnormal labs included pancytopenia and
elevation of liver function tests. Initial clinical impression
favored a viral illness with secondary pancytopenia. The patient
was discharged and returned 1 month later with spiking fevers
and abdominal distention. Imaging demonstrated hepatomegaly
and numerous solid, oval liver lesions which were hypoechoic
on US and hypodense on CT. On MRI with IV Eovist the
lesions were T1 & T2 hyperintense and hypointense on
hepatocyte phase. A skeletal survey was normal. Differential
considerations included infection, neoplasm and metastatic
disease. Percutaneous biopsy of two liver lesions was performed
and pathology confirmed juvenile xanthogranuloma (JXG). Our
patient received chemotherapy (Velban and Prednisone) that is
typically used for Langerhans cell histiocytosis. 4 months later
the patient's symptoms and labs had normalized and CT
demonstrated near complete resolution of liver lesions.
Conclusions: JXG is a rare form of non-Langerhans cell
histiocytosis typically diagnosed before the age of 1.95% of
cases present as isolated cutaneous disease with yellow, brown
skin nodules involving the head, neck and trunk. Prognosis is
favorable and skin lesions remain stable or gradually regress
without treatment. Organ involvement is rare, occurring in only
5% of all cases and can present with or without cutaneous
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S149
disease. Organs commonly involved include the orbit, lung,
muscle, CNS, liver, spleen and heart. Systemic JXG is
associated with an increased risk of serious complications
requiring aggressive medical therapy. Our patient presented
with multiple liver lesions, but lacked cutaneous disease.
Imaging findings on CT, US and MRI were non-specific, but
critical to assess sites and extent of disease. Percutaneous
biopsy was necessary to establish the diagnosis of systemic
JXG. Chemotherapy led to a favorable response. This rare
histiocytic disorder should be considered in a young child
presenting with imaging findings of multiple liver lesions, and
when present, skin lesions are helpful to establish the correct
diagnosis.
Poster #: CR-005
Mimicker or a sinister lesion- Inflammatory myofibroblastic
tumour, a diagnostic enigma unveiled.
Sreekumar Muthiyal, MBBS DMRD DNB M Med FRCR,
[email protected]; Viswanatha Kini, MD DNB FRCR,
Sheeja M. Koshy, MD; Hamad General Hospital , Doha, Doha,
Qatar
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Inflammatory myofibroblastic
tumour is a rare quasineoplastic lesion in the gatrointensitnal
tract ; often present with variable and nonspecific imaging
features, which may mimic other more common lesions,
including malignancy. Occurrence in early infancy involving
mesentery has been only sparsely reported in literature. We
present such a paradigm in a 4 months old infant with clinical,
radiological and histopathological features and corroborative
overview of literature.On Ultrasound abdomen, a mass lesion
measuring about 6x4cm with irregular lobulated margin in the
left lumbar–iliac fossa regions , involving the mesenteric planes
and contigous descending colonic wall, having heterogeneous
echotexture was seen . No calcification or cystic component was
evident . Left kidney and spleen were seen separately . On
Doppler it showed a few areas of vascularity.On MRI ,It
measured about 6.1x5.1x5.2 cm in CC, TR and AP dimensions
with lobulated margins, involving the mesentery. It was
heterogeously hypo intense on T1 W images and hyper intense
on T2W images. On DW sequences, a few areas of restricted
diffusion , predominantly along the periphery of the lesion,
while the central areas showed minimal/non-restriction ; which
also reflected in ADC map. On post contrast, the lesion showed
moderate heterogeneous enhancement corresponding to the
areas of restricted diffusion and dominant non enhancing
components, suggesting areas of necrosis. Apart from
contiguous colonic wall involvement , no other evidence of loco
regional infiltration or metastasis was seen. Based on these, a
diagnosis of Inflammatory myofibroblastic tumor was
made.with differential diagnosis of non Hodgkin's
lymphomaThe patient subsequently underwent laparotomy. On
Histopathology, it showed myofibroblastic spindle cells and
inflammatory infiltrates of lymphocytes with no evidence of
nuclear pleomorphism or atypical mitosis ; suggesting the
diagnosis of inflammatory myofibroblastic tumour ; which
matched the MRI diagnosis.
Conclusions: Inflammatory myofibroblastic tumour is a rare
quasineoplasm with a myriad of radiological features, vary from
that of a dormant benign lesion to an aggressive malignant
neoplasm. The indexed case is unique as its occurrence is in
early infancy with mesenteric involvement and similar cases
have been only sparsely reported in the literature. Awareness of
this entity is imperative in evaluation of pediatric abdominal
mass lesions; which may be a mimicker than a sinister lesion.
Poster #: CR-006
Fatty Falciform Ligament Appendage Torsion: Diagnosis
and Management in a Pediatric Patient.
Richard D. Horak, DO1, [email protected]; James Mega,
MD1, Phillip Tanton2, Erik Criman, MD1, Benjamin Tabak,
MD, FACSI MAJ, MC, USAI1, Veronica J. Rooks, MD1; 1Radiology, Tripler Army Medical Center, Honolulu, HI, 2University of Illinois Urbana-Champaign, Champaign, IL
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Fatty falciform ligament appendage
torsion (FFLAT) is a rare phenomenon as there are only two
reported pediatric cases of falciform ligament fatty appendage
torsion in the literature. In this case, the diagnosis was
established via ultrasound (US) and confirmed with computed
tomography (CT). US showed an echogenic, ill-defined mass in
the epigastric region that extending into the falciform ligament.
CT showed the “hyperattenuating rim” sign. This report is the
first reported female pediatric case of FFLAT that was
diagnosed with US and CT, given a trial of analgesics, and
definitively cured via minimally invasive surgical excision. A
13-year-old female presented to the emergency department with
episodic waxing and waning abdominal pain for three days. The
pain had localized to the mid-epigastrium and worsened with
deep inspiration. On examination, vital signs were within
normal limits. Focal tenderness was elicited upon palpation of
the epigastrium. Laboratory evaluation revealed a mild
leukocytosis 14.2 x 109/L, normal range (3.9-10.6 x 109/L).
Results: Ultrasound demonstrated an irregularly marginated
hyperechoic mass in the epigastric region that extended into
falciform ligament. Confirmatory CT scan of the
abdomen/pelvis with IV and oral contrast revealed mass-like
stranding of the intraperitoneal fat in the epigastric region with a
classic ovoid hyperattenuating rim sign. The vessels extending
into the falciform ligament did not demonstrate contrast
enhancement further raising concern for torsion. Surgical
consultation was obtained. Conservative management was
recommended via a trial of non-steroidal anti-inflammatory
medication. Despite several weeks of treatment, the patient’s
pain persisted without significant improvement. Transumbilical
laparoscopic excisional findings strongly suggested an acute on
chronic inflammatory process confined to the fatty appendage
of the falciform ligament. The pathologist described the resected
mass as fibrofatty rubbery tissue. The pre-operative diagnosis of
FFLAT was confirmed. The patient was found to have complete
resolution of pain at her two-week post-operative follow-up.
Conclusions: This case reiterates the clinical multidisciplinary
team approach required to diagnose the rare case of FFLAT in a
pediatric patient. It also demonstrates careful observation of
conservative management, and optional minimally invasive
surgical resection for patients with persistent symptoms.
Poster #: CR-007
Reactive Appendicitis Associated with Abdominal Solid
Organ Injury
Jane Tong2, Yu Luo1, [email protected]; 1Vanderbilt
University, Nashville, TN, 2Drexel University, Philadelphia,
PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Although acute appendicitis is
thought to be result from luminal obstruction of the appendix,
rarely it may develop following abdominal trauma. Traumatic
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S150
appendicitis is thought to occur through direct injury to the
appendix, or as a response to other abdominal organ injury. On
the other hand, in patients with other organ injury, some
distension of the appendix can occur with surrounding free fluid
secondary to trauma, mimicking appendicitis. While the clinical
presentation of traumatic appendicitis is similar to that of
traditional appendicitis, differentiation between reactive
appendiceal changes in the setting of traumatic injury to other
intra-abdominal organs is important, as the latter will not
require appendectomy. We present two pediatric patients in
whom following initial suspicion of acute appendicitis,
ultrasonography (US) identified mildly enlarged fluid-filled and
hyperemic appendix with out of proportion complex fluid,
raising the suspicion of previously unsuspected abdominal
trauma. Upon further examination, injury to other abdominal
solid organs was discovered as the primary cause of patient's
presentation and appendiceal findings were reactive to
abdominal solid organ injury. In cases of suspected appendicitis,
visualization of significant free fluid with dense debris on
ultrasonography (US) calls for more careful examination to
assess clues of other abdominal injury.
Poster #: CR-008
Reflux of contrast during voiding cystourethrogram to the
peritoneum in an otherwise healthy female patient
Abraham Noorbakhsh, MD1, [email protected]; Jeffrey
Koning2, Peter Kruk2; 1Radiology, University of California, San
Diego, San Diego, CA, 2Rady Children's Hospital, San Diego,
CA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: We report a case of a 7 year old
female who presented to urology clinic due to recurrent urinary
tract infections that had started 4 years ago. The patient also
reported symptoms of urge incontinence and nocturnal enuresis
beginning at the same time. She previously consulted an adult
gynecologist, which showed no physical exam evidence of
genitourinary abnormalities. An MRI of the abdomen and pelvis
was also ordered at that time which reported a normal exam
except for a small left renal cyst. At our institution she
underwent DMSA renal scan, which was normal. She
underwent a voiding cystourethrogram (VCUG), which showed
no vesicoureteral reflux. However, during the VCUG, an
incidental note was made of large amounts of vaginal reflux
extending into the cervix, uterus, and with spillage into the
peritoneal cavity presumably via the salpinges.
Conclusions: Extension of contrast into the peritoneal cavity
via vaginal reflux on VCUG has previously been reported only
in patients with genitourinary anomalies. However, this patient
had prior workup demonstrating no definite genitourinary
abnormalities. This case suggests that reflux of contrast to the
peritoneal cavity may be possible in patients with otherwise
normal genitourinary anatomy.
Poster #: CR-009
Extramedullary Hematopoiesis Masquerading as Metastases
in Liver in a Known Case of Neuroblastoma with
Opsoclonus-Myoclonus Syndrome
Abhijeet Taori, MD, DNB, EDiR, [email protected]; Nazih
Shenouda; Medical Imaging, CHEO, University of Ottawa,
Ottawa, Ontario, Canada
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Extramedullary hematopoiesis (EH)
is defined as hematopoiesis occurring in organs outside of the
bone marrow. It occurs in diverse conditions, including fetal
development, normal immune responses, and pathological
circumstances. These sites of extramedullary hematopoiesis
may present as masses mimicking malignancy or produce
symptoms due to pressure effects. In the setting of an existing
malignancy they may appear as metastatic deposits signifying
progression of disease. It is essential to confirm this due to its
prognostic and treatment implications.We report a 2-year-old
little girl who presented initially with an acute history of ataxia,
nystagmus, tremor, mydriasis and bruises on her left forehead.
A solid left suprarenal mass was detected and a diagnosis of
Stage 4 Neuroblastoma and Opsoclonus-Myoclonus syndrome
was established. Subsequently she was on treatment which
included chemotherapy, IVIG and stem cell transplant. On an
MRI of the abdomen done a year later, a single lesion was
detected in the right lobe of the liver. On subsequent short term
follow up, innumerable scattered lesions were seen in the
hepatic parenchyma and were thought to represent metastases.
A liver biopsy showed that these hepatic lesions represented
sites of extramedullary hematopoiesis.Extramedullary
hematopoiesis has been uncommonly seen in the cranium and
sacrum in the setting of Neuroblastoma. We believe this is a
unique presentation with extramedullary hematopoiesis
presenting as solid liver masses masquerading as metastases in a
known case of Neuroblastoma.
Poster #: CR-010
Role of diagnostic and interventional radiology in a
successful separation of conjoined thoraco-omphalopagus
twins
Christopher J. Yen, MD1, [email protected]; Kamlesh Kukreja,
MD2, Prakash M. Masand, MD2; 1Radiology, Baylor College of
Medicine, Houston, TX, 2Texas Children's Hospital, Houston,
TX
Disclosures: Prakash M. Masand, MD: Consultant,
Honoraria: Canon Medical Systems, Phillips MRI Users
Meeting 2018, Daiichi Sankyo, Speakers Bureau: Canon
Medical Systems, Royalty: Amirsys. All other authors have
disclosed no financial interests, arrangements or affiliations in
the context of this activity.
Purpose or Case Report: Female conjoined throraco-
omphalopagus twins were delivered via cesarean section at 35
weeks 5 days gestational age to a 38-year-old mother who
received standard prenatal care. After resuscitation, the twins
were transferred to the neonatal ICU, where they remained for
monitoring and growth as they were assessed for potential
separation.CT angiography was performed at 3-4 months of life
using a staged approach. Selective IV and oral contrast
administration was used over two visits to delineate shared and
non-shared structures. Most significantly, there was a single
shared liver with anomalous hepatic venous drainage. Twin A
had three normal caliber hepatic veins draining into a normal
IVC, but a large branch of the middle hepatic vein traversed
midline into Twin B and received hepatic venous drainage from
Twin B via numerous anomalous vessels. Twin B had a normal
IVC but three diminutive hepatic veins, thought to be due to
reduced venous drainage as a result of the anomalous shared
vasculature.After multidisciplinary discussion, interventional
radiology was consulted for hepatic venogram and intervention
as needed. The anomalous communicating vessels were
identified on hepatic venogram via Twin A femoral approach.
Occlusion of the anomalous branches was achieved with serial
embolization of the primary draining vessel on the Twin A side
using Amplatzer vascular plugs. Successful occlusion was
confirmed on venography after the final embolization
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S151
procedure.Follow-up Doppler ultrasound exams confirmed
improved hepatic venous outflow in Twin B, initially with
reversal of flow in the anomalous veins back toward the IVC of
Twin B, followed by nonvisualization of the anomalous veins
on later exams. CT angiography later showed enlarged caliber
of the native Twin B hepatic veins. Following the optimization
of hepatic venous outflow, the multispecialty surgical team
proceeded with separation. The twins were separated at 13
months of age without complication. In addition to restoring
venous outflow to allow for a successful surgical outcome, it
was noted that the Amplatzer devices were used as surgical
landmarks during separation for identification of shared
anatomy. Through careful planning and execution, diagnostic
and interventional radiology techniques played a critical role in
this successful outcome.
Poster #: CR-011
BioPlug Utilized for Closure of Esophagocutaneous Fistula
Brittany Johnson, MD, [email protected]; Sudhen
Desai, MD, Paul Minifee, MD; Pediatric Surgery , Texas
Children’s Hospital , Houston , TX
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Introduction: The management of
gastrobronchial fistula (GBF) is not well defined in the
literature. First line management is non-operative, allowing time
for the fistula to close naturally. Surgical intervention is
implemented when non-operative management fails. In
medically complex patients, who often fail non-operative
management, surgical procedures for closure remain high risk
for complications.Case: We present a 2 year-old female with
congenital esophageal atresia, duodenal atresia and annular
pancreas. Beginning October 2015, she underwent multiple
surgical procedures resulting in a multitude of complications. In
August 2017, she transferred to our institution for management.
Additional immediate operative intervention was pursued given
the presence of the GBF. Despite two attempts at operative
repair, the fistula recurred. Interventional radiology, consulted
March 2018, developed a plan to place a percutaneous pigtail
catheter in the esophagus through the dehiscent stomach wall
from an external chest tube entry site, creating an iatrogenic
enterocutaneous fistula (ECF). Diversion of flow from the GBF
to the ECF was hypothesized to allow a conservative alternative
for closure and tissue healing to occur. Initially, a 12 French (F)
pigtail catheter was placed through the gastric wall into the
esophageal pouch allowing the formation of the ECF tract. The
patient returned for catheter downsizing to 8F three weeks later.
A third intervention was performed to reposition the catheter to
ensure that the tissues remained as dehydrated as possible. In
May 2018, a 7 mm Cook Biodesign SIS fistula plug was placed.
The 8F catheter was used to place a guide wire through the tract,
then removed. The AFP bioplug, soaked in contrast to facilitate
use of fluoroscopy, was placed through the mouth to seal the
gastric wall. Placement was confirmed with a rigid
esophagoscope and fluoroscopy. One week later, esophogram
confirmed no leak. At 1 month follow-up the patient had no
evidence of right pleural fluid and remains without evidence of
fistula at five months. The skin site is well-healed.Discussion:
In this case, an ECF was closed with a Cook Biodesign SIS
fistula plug allowing for a successful non-operative strategy
after multiple failed operative revisions. The plug has FDA
approval for the treatment of anal fistula, but given the positive
outcome in this case, its use in esophagocutaneous fistulas may
be a viable off-label option for other patients.
Poster #: CR-012
Leptomeningeal Melanocytosis: A Lethal Cause of Pediatric
Seizures
Sophia Xie, MD, [email protected]; Cory M. Pfeifer, MD;
Radiology, University of Texas Southwestern, Dallas, TX
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Leptomeningeal melanocytosis is a
rare proliferation of melanocytes in the arachnoid and pia mater
that presents as diffuse leptomeningeal enhancement. Findings
in a rare case of this disorder are discussed along with
differential considerations and diagnostic implications.
Methods & Materials: A 9-year-old male presented to the
emergency department after hitting his head on the door of a
car. CT of the head performed at that time showed minimal high
attenuation material throughout the right parietal cortical
reported as a small amount of subarachnoid hemorrhage. After
it became clear that the patient was having uncontrolled seizures
that may have contributed to the original trauma, he was placed
on anti-epileptic medication and referred for MRI.
Results: Multiple MRI's were performed with and without
contrast over the next 6 months. The findings on the CT were
found to be due to thickening of the leptomeninges which
exhibited robust contrast enhancement, greatest in the right
parietal lobe. Multifocal hemorrhages were observed in the left
cerebral hemisphere over the course of the exams. A diagnosis
of Sturge-Weber Syndrome was assigned. Since the
leptomeningeal enhancement showed progression over 5
months, a surgical biopsy was performed. Upon entry into the
calvarium, the surface of the brain was found to be dark brown
in color. Biopsy revealed the diagnosis of leptomeningeal
melanocytosis.
Conclusions: Leptomeningeal melanocytosis is a rare disorder
that can be confused with infectious, inflammatory, and/or
vascular abnormalities. The disease is typically fatal with a
short life expectancy following diagnosis. Careful attention on
follow-up of leptomeningeal enhancement is essential to
exclude a proliferative or neoplastic process.
Poster #: CR-013
Rest assured, it's benign: Intrathyroidal thymic rests
Adina Alazraki, MD, [email protected]; Sarah Milla,
MD; Children's Healthcare of Atlanta, Atlanta, GA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Ectopic thymic tissue may be found
in the neck in up to 20% of the general population.
Intrathyroidal thymic rest has been described as a rare entity,
present in as many as 1% of children. The course of thymic
migration parallels the thyroid and parathyroid glands, which
explains their similar ectopic locations. While the natural
history of these lesions has not been well studied, it is likely that
there is involution of thymic rests with age. A few individual
case reports have described the imaging features of
intrathryoidal thymic rests confirmed by histopathology and
flow cytometry. The aim of this case series is to raise awareness
of the characteristic sonographic appearance of this entity to the
radiology community.
Methods & Materials: This case series will review clinical and
imaging features of 4 biopsy-proven intrathyroidal thymic rests.
Characteristic imaging features will be elucidated. Differences
between this entity and more concerning thyroid nodules that
require biopsy and perhaps excision will be highlighted.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S152
Results: The presence of dot-dash echogenic foci within a focal
hypoechoic nodule are characteristic for thymic rests but can be
mistaken for more worrisome calcifications in a thyroid nodule.
Additionally, the border can be lobulated and somewhat
irregular, which is another significant feature of suspicious
thyroid nodules by TiRADS criteria.
Conclusions: The sonographic appearance of thymic rests
within the thyroid gland is very characteristic and should be
suggested in the differential diagnosis of an incidentally found
characteristic nodule in an otherwise healthy child. These
nodules do not follow TiRADS criteria for benignity, however,
radiologists should be aware of this entity. When patients have
this classic appearance , conservative management should be
considered, with less invasive sampling with fine needle
aspiration favored over surgical excision if there remains
clinical concern.
Poster #: CR-014
In the Chest, the Abdomen, and the Pelvis: 3 Cases of
Inflammatory Myofibroblastic Tumors in Children in
Varied Locations
Jane B. Lyon, M.D., [email protected]; Hau D. Le,
M.D.; Department of Radiology, University of Wisconsin
School of Medicine and Public Health, Madison, WI
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Inflammatory Myofibroblastic
Tumor (IMT) is now considered a distinct entity and a true
neoplasm within the heterogeneous group of inflammatory
mass-forming tumors. It is now recognized as a
fibroblastic/myofibroblastic neoplasm with intermediate
biological potential. It occurs predominantly in children.
Abnormalities on Chromosome 2p23 with a rearrangement of
the ALK (anaplastic lymphoma kinase) locus causes abnormal
tyrosine kinase receptor expression. Chromosomal
abnormalities suggest a clonal origin and not just a reactive
process or “pseudotumor,” as these masses have been
categorized in the past. Up to sixty percent of inflammatory
myofibroblastic tumors express ALK which may help establish
the diagnosis of the inflammatory mass as an IMT. The masses
can occur in a variety of locations and have non-specific
imaging findings, which will be reviewed.We present three
cases, each in a different location:Case 1: 7 year old female
presents with chronic cough and persistent right middle lobe
abnormality on chest x-ray with concern for pneumonia or
inhaled foreign body. She was found to have a soft tissue mass
in her right mainstem bronchus with extra-luminal extension.
CT, MR and gross surgical photos of the endobronchial
IMT will be presented.Case 2: 20 month old male presents with
hepatomegaly, jaundice and elevated bilirubin, alkaline
phosphatase and liver function tests. Ultrasound and MR images
of the pancreatic head IMT causing biliary obstruction will be
presented.Case 3: 13 year old male presents with back, leg and
pelvic pain. MR, CT and gross surgical photos of the right
posterior pelvic sidewall IMT, which had evidence of nerve
entrapment at biopsy, will be presented.The imaging,
pathological and surgical findings from these patients, where
available, will be presented and reviewed.We suggest that the
radiologist consider Inflammatory Myofibroblastic Tumor in the
differential diagnosis for inflammatory and fibrous lesions in
children.
Poster #: EDU-001
Born To Be Wide: Aortopathy and Thoracic Aortic
Aneurysm in Children
Andrew B. Wallace, [email protected]; Demetrios Raptis,
MD, Sanjeev Bhalla, MD; Mallinckrodt Institute of Radiology,
Saint Louis, MO
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: This case-based, pictorial,
educational exhibit will:1. Examine the predisposing conditions
of thoracic aortic aneurysm (TAA) in children2. Illustrate the
histopathologic and imaging features of these conditions3.
Demonstrate proper technique for measuring and reporting
aortic dimensions in children4. Review treatment options for
TAA and how treatment depnds on the underlying disease and
imaging findings
Methods & Materials: There are several inherited disorders
and congenital defects that predispose to progressive dilation of
the thoracic aorta in childhood. Well known disorders like
Marfan syndrome and bicuspid aortic valve have long served as
clinical models but many, seemingly disparate, disorders result
in similar abnormalities of the aorta. As knowledge about the
genetic and histopathologic underpinnings of TAA grows,
management will be guided by multidisciplinary teams. In order
to maintain value in these teams, the pediatric radiologist must
understand the varied causes of TAA, the underlying
histopathology, and the treatment implications. This exhibit will
introduce these predisposing conditions, review the similarities
and differences, and review treatment options.
Results: The following conditions that predispose to aortic
aneurysm will be reviewed:I. Extracellular Matrix Proteins1.
Marfan Syndrome2. Ehlers-Danlos Syndrome3. Alport
Syndrome4. Cutix Laxa5. MFAP5 Gene MutationII. TGF-ß
Signaling Pathway1. Loeys-Dietz Syndrome2. Osteoarthritis-
Aneurysm Syndrome3. Sphrintzen-Goldberg Syndrome4.
Arterial Tortuosity Syndrome5. SMAD2 and SMAD4 Gene
MutationsIII. Nonsyndromic Familial Thoracic Aortic
Aneusysms and Dissections Gene Mutations1. ACTA22.
MYH113. MLK4. PRKG15. FLNA6. MAT2AIV. Congenital
Heart Disease1. Bicuspid Aortopathy2. Aortic Coaractation3.
Tetralogy of Fallot4. Truncus Arteriosus5. Hypoplastic Left
Heart Syndrome6. Ross Procedure7. Arterial Switch Procedures
Conclusions: Seemingly disparate conditions converge to cause
similar aortopathies, resulting in TAA. As knowledge about
aortopathy expands, pediatric radiologists must maintain
knowledge about the defects and disorders linked to TAA,
understand expected patterns of aortic dilation in the different
conditions, and provide meaningful information to colleagues in
cardiology and surgery. In doing so, radiologists will maintain
value in the multidisciplinary approach these conditions
warrant.
Poster #: EDU-002
Unpacking the trunc: Imaging of Truncus Arteriosus
Erin Romberg, MD, [email protected]; Sadaf
Bhutta, MD; Radiology, Seattle Children's Hospital, Seattle,
WA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Truncus arteriosus is a rare
congenital cardiac anomaly characterized by failure of
conoseptal separation resulting in a single arterial trunk
supplying both the pulmonary and systemic circulation.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S153
Diagnosis has historically been made with fetal
echocardiography, and palliative surgery performed frequently
in the neonatal period. Cross-sectional imaging is typically
reserved for post-operative complications. However, due to
lower dose radiation and faster scanners, preoperative CT
angiography imaging is becoming more common with the
increasing use of cardiac EKG-gated CT angiograms, requiring
pediatric imagers to be familiar with the diagnosis of the truncus
arteriosus spectrum.
Methods & Materials: This retrospective imaging review will
describe the imaging features of truncus arteriosus, including
the 2-D multiplanar reformatted images and 3-D volume
rendered images. Various anatomical types of Truncus
Arteriosus detailed in the widely used Van Praagh classification
will be demonstrated. Illustrative examples will also detail
variants not clearly defined by the current classification
systems. Important imaging distinctions between truncus
arteriosus and other similar appearing congenital cardiac
anomalies, such as Tetralogy of Fallot or pulmonary atresia with
major aorto-pulmonary collateral arteries, will be described.
Conclusions: This educational exhibit will provide viewers with
a framework to recognize and classify truncus arteriosus, as
well as provide vital distinction between truncus arteriosus and
other similar appearing conotruncal anomalies.
Poster #: EDU-003
Practical Use of Compressed Sensing in Clinical Pediatric
Cardiovascular MRI: The Low Hanging Fruit.
Taylor Chung, MD1, [email protected]; Mariya
Doneva, PhD3, Quin Lu, PhD2, Dave Hitt2, Jonathan I. Tamir4; 1UCSF Benioff Children's Hospital Oakland, Oakland, CA, 2Philips Healthcare, Gainesville, FL, 3Philips Research,
Hamburg, Germany, 4University of California Berkeley,
Berkeley, CA
Disclosures: Mariya Doneva, PhD: Salary: Philips Research;
Quin Lu, PhD: Salary: Philips; Dave Hitt: Salary: Philips
HealthTech; Jon Tamir, PhD: Consultant, Honoraria & Equity
Interest/Stock Option: Subtle Medical, Research Grants: GE
Healthcare. All other authors have disclosed no financial
interests, arrangements or affiliations in the context of this
activity.
Purpose or Case Report: This electronic educational poster
will first introduce the concept behind Compressed Sensing - a
very powerful MR technique (that has just become
commercially available in 2018) allowing for, amongst many
different applications, acceleration of MR data acquisition
beyond parallel imaging (SENSE, GRAPPA, ASSET). Then,
the poster will show comparative clinical examples of
application of Compressed Sensing onto commonly used
cardiovascular MR sequences such as 1) cine balanced SSFP,
both breath-hold and non-breath-hold examinations, 2) cine
phase contrast in free-breathing, and 3) respiratory-navigated
3D Whole-Heart examination using T1-weighted fast gradient
echo sequence with DIXON technique. In these clinical
examples, Compressed Sensing, in addition to parallel imaging,
can further accelerate the acquisition time to allow for less
number of breath-holds for patients to complete a stack of cine
images through the ventricles without sacrificing spatial or
temporal resolution or signal-to-noise ratio. The acquisition
time of free-breathing cine phase contrast can be reduced and
yield accurate flow quantification. The increased speed of
acquisition can be traded off to achieve higher spatial resolution
in young patients who may not be able to achieve long breath-
hold times otherwise needed when high spatial resolution is
necessary. These clinical examples were accumulated since
January 2017 with a Compressed Sensing software patch made
available by the scientific research group of the MR vendor
under research agreement and the clinical use was approved by
Institutional Review Board.
Poster #: EDU-004
Pediatric congenital arterial switches: on or off?
Jennifer Wu1, [email protected]; Ross A. Myers, MD1,
David Sadowsky, MD1, Tianyang Li, MD1, Edison Tsui2,
Pierre-Yves Sonke1; 1Westchester Medical Center, Valhalla,
NY, 2Columbia University, New York, NY
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Congenital heart diseases often
occurs secondary to a variety of insults and rotational errors
during development in utero. These can range from a spectrum
of simple to more complex pathologies including arterial
switches. It is important for radiologists to recognize the
embryology and complications of arterial switches to further
management. Today largely secondary to new advances in
technology both corrected and uncorrected arterial switches are
diagnosed more commonly; previously many patients with
arterial switches may not have survived into adulthood.In utero,
the primitive truncus is normally positioned anterior and
midline. It eventually divides into the aorta and the pulmonary
artery, which then rotates clockwise 150 degrees such that the
pulmonary artery lies anterior to and left of the aorta. When
variations occur it can result in a congenitally corrected
transposition such as L- transposition of the great arteries (L-
TGA) where the two ventricles are morphologically switched in
position. With L-TGA, the truncus rotates 30-degrees clockwise
which results in the aorta being anterior and leftward in relation
to the pulmonary artery.In uncorrected transposition (R-TGA)
the aorta arises from the right ventricle and the pulmonary
artery arises from the left ventricle, secondary to a 30-degree
counterclockwise rotation of the primitive truncus, the aorta is
then located rightward and anterior to the pulmonary artery.
This condition needs to be corrected surgically due to cyanosis
resulting from the right ventricle not being able to supply the
systemic circulation. Other variations of arterial switches that
can occur is situs inversus where the rotation of the aorta and
pulmonary artery is completely opposite of that which would be
considered normal. Lastly in truncus arteriosus, the primitive
truncus does not divide into a separate aorta and pulmonary
artery. We will provide several cases from our institution of
arterial switches on imaging as well as diagramatic
representative models describing the embryology of how arterial
switches and rotations occur. We also discuss the repairs and
complications of these cases.
Conclusions: Congenital arterial switches and complications
from repairs can be confusing but are becoming more
commonplace. It is thus important for radiologists to understand
the embryology and identify the imaging characteristics.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S154
Poster #: EDU-005
RASA1 mutations associated with capillary malformation-
arteriovenous malformation: imaging findings
Frederic Thomas-Chausse, MD1, frederic.thomas-
[email protected]; Maïa Proisy, M.D1, Catherine
McCuaig, MD2, Francoise Rypens, MD1, Chantale Lapierre,
MD1, Josée Dubois, MD1; 1CHU Sainte-Justine, Medical
Imaging Department, Montreal, Quebec, Canada, 2CHU Sainte-
Justine, Department of Pediatrics, Montreal, Quebec, Canada
Disclosures: Maïa Proisy, M.D.: Research Grants: Société
Francaise de Radiologie, Région Bretagne (France). All other
authors have disclosed no financial interests, arrangements or
affiliations in the context of this activity.
Purpose or Case Report: Capillary malformation-
arteriovenous malformation (CM-AVM) is an autosomal
dominant disorder with variable phenotype caused by
heterozygous inactivating mutations in the RASA1 gene located
on chromosome 5. Clinical manifestations are variable with
cutaneous multifocal capillary malformation associated with
fast-flow lesions. Most of them are located in soft tissues
(intramuscular, intraosseous, spinal or cerebral). Many authors
reported the clinical spectrum or the genetic association but few
data are available on the imaging characteristics or criteria to
establish the diagnosis of AVM. The goal of this poster is to
review the imaging characteristics in the RASA1 series of our
institution and in particular to evaluate the distribution of
patients having true AVMs versus capillary hypervascularity.
Methods & Materials: A retrospective study of clinical and
imaging files was conducted for all patients seen in our vascular
anomalies group with a genetic diagnosis confirmation of
RASA1 mutation. Institutional approval was obtained from the
IRB and all patients (or parents) signed an informed consent.
We reviewed 9 cases (8F, 1M) with RASA1 mutations.
Cutaneous capillary malformation aspect, color Doppler
ultrasound and MR findings will be described. Lung AVM has
never been reported in RASA1 except in our series.
Conclusions: Patients with RASA1 mutations have a wide
spectrum of clinical manifestations. CM is the clue for the
diagnosis, particularly if the CM has the pale halo. However, the
AVM criterion for extracranial lesions has to be clarified. Most
lesions in our series behave more like a capillary
hypervascularization without AV shunting. Thus, the presence
of extracranial/spinal true AVMs seems to be rare. The
integration of genetic, clinical and imaging findings is important
to have a better understanding of the disease and to offer the
best treatment.
Poster #: EDU-006
Thinking Outside The Heart-Shaped Box- A Pictorial
Review of Extracardiac Complications of Congenital Heart
Disease in Infants.
Jamie Frost, DO,[email protected]; Michigan State
University, Grand Rapids, MI
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Congenital heart disease (CHD) is
the most common type of birth defect; affecting ~1% of the
births per year in the U.S. Advancements in medical and
surgical treatment have markedly improved survival and even
infants with complex CHD survive into adulthood. However,
extracardiac complications in the newborn period can cause
increased morbidity and mortality. These complications can
relate to alteration in flow dynamics, treatment changes, and/or
sequelae of associated syndromes (Trisomy 21, 22q deletion
syndrome, Heterotaxy, PHACES). The purpose of this exhibit is
to highlight extracardiac complications of CHD and to review
their imaging findings. Imaging findings to be reviewed will
include catheter thromboses, necrotizing enterocolitis, arterial
ischemic strokes, infections, malrotation, pulmonary
complications related to prematurity, prolonged intubations, and
associated syndromes, and complications of extracorporeal
membrane oxygenation. The goal of this exhibit is to familiarize
radiologists with the multiplicity of extracardiac complications
in infants with CHD and to review the common imaging
findings.
Poster #: EDU-007
The Varied Manifestations of Cystic Renal Disease on Fetal
MRI: What the Radiologist Needs to Know
Nicole P. Steinhardt1, [email protected]; Mariana L. Meyers,
MD2, Brandon P. Brown, MD, MA1; 1Radiology and Imaging
Sciences, Indiana University School of Medicine, Indianapolis,
IN, 2Children's Hospital Colorado - CFCC, Aurora, CO
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Fetal MRI is now an important
adjunct imaging modality in the evaluation of complex fetal
anomalies, including cystic renal disease. The improved
resolution and anatomic detail of the renal parenchyma offered
by MRI can assist with identification, localization, and
characterization of cystic lesions which are less clearly
visualized on ultrasound. Advanced imaging adds value through
enabling prenatal prognostication and patient counseling. In this
presentation, we evaluate the spectrum of renal cystic
abnormalities at the microscopic and macroscopic scale, and
review the patterns of disease by cyst location, effect on
parenchymal integrity, and obstruction of the collecting system.
A clearer understanding of the diverse appearances and broad
spectrum of outcomes of these fetal anomalies can contribute to
more detailed treatment planning and more precise, family-
centered care.In this presentation, we review the varied patterns
of cystic renal disease as identified on fetal MRI, highlighting
those forms known to be more associated with perinatal
morbidity and mortality. Further, we correlate their appearance
on MRI with pre- and post-natal US imaging, as well as
pathologic findings. Finally, we will describe secondary
prenatal imaging biomarkers that may be valuable in counseling
and also with both definitive and palliative surgical planning.
Poster #: EDU-008
Contrast-enhanced ultrasound for the evaluation of the
neonatal brain: Diagnostic methods and scanning protocol
Kayla Cort, DO, [email protected]; Maciej
Piskunowicz, MD, Misun Hwang, MD; Children's Hospital of
Philadelphia, Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Contrast-enhanced ultrasound
(CEUS) for the evaluation of the neonatal brain provides
additional diagnostic information when compared to
conventional gray scale ultrasound through the detection of
perfusion abnormalities associated with injury. When compared
to cross-sectional imaging, CEUS has many advantages given
its relative low cost and ability to be performed at the bedside,
without the need for sedation or exposure to ionizing radiation.
Diagnostic information is yielded through the qualitative
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S155
evaluation of parenchymal enhancement patterns as well as
quantification of microbubble perfusion kinetics from which
time intensity curves are derived and additional perfusion
parameters can be extrapolated. Given the 2-dimensional nature
of the modality, a strategically designed scanning protocol is
necessary to obtain the aforementioned quantitative values. The
purpose of this exhibit is to demonstrate the current
understanding of brain CEUS and educate on the brain CEUS
protocol used for the diagnosis of neonatal brain pathology.
Poster #: EDU-009
Spotlight on the Fetal Eye: A Review of Prenatal Orbital
Malformations
Eman S. Mahdi, M.D.1, [email protected]; Matthew
Whitehead, MD2, Mohannad Al-Samarraie, M.D.1, Dorothy
Bulas, MD2; 1Radiology department, University of Missouri
Hospital, Columbia, MO, 2Children's National Health System,
Washington, DC
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Congenital eye malformations are
relatively rare. However, they are often associated with complex
clinical syndromes that require extensive prenatal evaluation
and counseling. The purpose of this study is to provide a review
of various congenital ocular anomalies that can be detected on
prenatal ultrasound and/or MRI in isolation or as part of a
syndromic findings and to address the importance of the
prenatal genetic evaluation and parental counseling.
Methods & Materials: A retrospective review of the radiology
database at our institution is performed. Various congenital
orbital malformations are reviewed using prenatal ultrasound
and/or multiplanar fetal MRI images.
Results: Presented orbital pathologies are:hypo/hypertelorism,
micro/anophthalmia, cataract, coloboma, optic nerve
hypoplasia, persistent hyperplastic primary vitreous and orbital
masses with discussion on the associated clinical syndromes.
Conclusions: Early prenatal diagnosis of ocular malformations
has an important role in appropriate genetic counseling and
postnatal management.The identification of orbital anomalies
can help in the search for associated cerebral or systemic
anomalies.
Poster #: EDU-010
The Extremely Low Gestational Age Infants: Neuro
Sonography of Normal Brain and Complications.
Abhijeet Taori, MD, DNB, EDiR, [email protected];
Emanuela Ferretti, MD, FRCPC, Elka Miller, MD, Claudia
Martinez-Rios; CHEO, University of Ottawa, Ottawa, Ontario,
Canada
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Advances in Neonatal Intensive Care
have led to substantial improvement in survival of preterm
infants of extremely low gestational age (ELGA) between 22+0
and 23+6 weeks gestation. ELGA newborns are more
susceptible to several complications of prematurity. Recognition
of the sonographic features of the normal brain and
identification of potential short and long-term complications of
these infants is paramount.High resolution transfontanellar
ultrasonography is the baseline “gold standard” of care imaging
modality to assess the integrity of the neonatal brain and
potential complications encountered in ELGA newborns. Color
and spectral Doppler US allows high reliability and precision in
the evaluation of the intracranial vasculature.The purpose of this
exhibit is1. To illustrate a spectrum of the sonographic features
of the normal developing brain in ELGA infants.2. To
characterize the sonographic findings of short and long-term
brain anatomical complications.3. To describe common pitfalls
when imaging these infants.
Poster #: EDU-011
Prenatal Imaging Evaluation of Disorders of Sexual
Development
Tara Cielma, [email protected]; Anna Blask, Eva Rubio,
Judyta Loomis, Meg Menzel, Dorothy Bulas, MD; Children's
National Medical Center, Washington, DC
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Background: Disorders of sexual
development (DSD) resulting in ambiguous genitalia are a rare
spectrum of anomalies that have the potential to be diagnosed
prenatally using a combination of genetic testing and imaging.
The incidence of prenatal detection is rising with the increased
use of noninvasive prenatal testing, which can reveal
discordance between genotype and phenotype.Sonographic and
MR imaging contribute to prenatal assessment of disorders of
DSD and may narrow the differential diagnosis and facilitate
prenatal testing and postnatal evaluation.The goals of this
exhibit are:1. Review imaging features of normal prenatal male
and female genitalia.2. Review imaging patterns of ambiguous
genitalia.3. Discuss changes in appearance with various
pathologies, providing imaging examples.4. Review different
categories of disorders of sexual differentiation and see how
imaging may narrow the differential diagnosis.
Methods & Materials: Fetal ultrasound and MR studies at our
institute were reviewed retrospectively with selected
representative cases chosen to illustrate technical aspects and to
demonstrate the imaging features in cases of ambiguous
genitalia. Correlation was made with NIPT, amniocentesis, and
CVS results in conjunction with follow up radiology studies,
and clinical or surgical outcomes.Categorical disorders of
sexual development, such as 46 XX, 46 XY, ovotesticular DSD
and sex chromosome will be described.
Results: Prenatal findings in the normal fetus and in disorders
of sexual development fetal will be illustrated with postnatal
correlation.
Conclusions: DSD is a complex group of disorders requiring an
understanding of anatomical variations of genitalia and the
diseases within each group. US and MR contribute to the
prenatal detection of DSD, help narrow the differential
diagnosis and help direct prenatal and postnatal genetic testing
and imaging.
Poster #: EDU-012
A Review of Cystic Pediatric Presacral Masses:
Sacrococcygeal Teratoma and Beyond
Ryan Murphy, MD, [email protected]; Michael A. Murati,
Tara Holm, Kelly Dietz, MD; Department of Radiology,
University of Minnesota, Plymouth, MN
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: The presacral space is composed of
multiple tissue types, including osteochondral, mesenchymal,
neurogenic, vascular and lymphatic. The presence of these
tissues leads to a long and complex differential for a presacral
mass in a pediatric patient. Specifically, the differential also
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S156
includes anterior sacral meningocele, enteric cyst, vascular
malformations, neuroblastoma, ganglioneuroma, schwannoma,
neurofibroma, rhabdomyosarcoma, lymphomatous masses, giant
cell tumor, aneurysmal bone cyst, osteosarcoma, Ewing
sarcoma, and chordoma. Imaging plays a key role in
characterizing these masses and treatment planning. Familiarity
with the common presacral masses of infancy and childhood is
therefore necessary for the pediatric and general
radiologist.Once an osteochondral or neurogenic mass is
excluded, and a predominantly cystic presacral mass is present,
the primary differential consists of a collection of
developmental or congenital masses including sacrococcygeal
teratoma, anterior meningocele, low flow vascular
malformation, and an enteric duplication cyst. We will review
the common imaging features and associations of these cystic
masses by presenting a series of cases. Additional examples of
solid and osteochondral presacral masses will be included where
appropriate for comparison in order to avoid characterization
pitfalls and highlight teaching points.
Poster #: EDU-013
Prenatal three-vessel and trachea view: the rationale behind
doing it.
Julie Dery, MD, [email protected]; Francoise
Rypens, MD, Juliette Garel, MD, Marie-Josee Raboisson, MD,
Chantale Lapierre, MD; Medical Imaging Department, CHU
Sainte-Justine, Montreal, Quebec, Canada
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Prenatal screening and diagnosis of
fetal anomalies rely upon ultrasound studies (US). US is
generally considered safe during pregnancy. It is estimated that
1% of all neonates are born with a congenital heart defect that
makes careful standardized examination of the fetal heart a
mandatory step during all fetal US exams. US examination of
the fetal heart requires at least analysis of the fetal situs, the
four-chamber (4CH) view and the three-vessel view (3V). In the
evaluation of the fetal heart, it is now worldwide accepted that
the three-vessel trachea (3VT) view should be obtained, if
technically feasible, in supplement of the other classical fetal
cardiac views (4CH, 3V).The relevance of adding the 3VT view
is that some congenital cardiovascular abnormalities, potentially
significant for fetal outcome, can only be diagnosed with this
view; these malformations include vascular rings and right
aortic arches.
Methods & Materials: We conducted a retrospective review of
prenatal US and cardiac US data of fetuses with abnormal 3VT
view, with correlation with postnatal imaging (CTA) and
outcome. The most frequent abnormalities detectable will be
illustrated and discussed: right aortic arch with retroesophageal
diverticulum of Kommerell, mirror-image right aortic arch, right
aortic arch with aberrant left subclavian artery, right circumflex
aorta, double aortic arch and left aortic arch with aberrant right
subclavian artery.The goals of this exhibit are:- To review the
normal appearance of the fetal 3VT view;- To review the
embryological development of aortic arches explaining the
malformations that can be observed;- To understand the
significance of abnormal appearance of the fetal 3VT view by
correlation with postnatal CT-scan imaging;- To propose a
practical algorithm and work-up regarding detection of an
abnormal 3VT view in a foetus;- To help radiologists provide
appropriate counselling to parents when discovering an
abnormal 3VT view in routine fetal screening.
Poster #: EDU-014
Assessment of Lower Extremity Anomalies in the Fetus
Richard Becker, MD, [email protected]; Eva I.
Rubio, MD, Dorothy Bulas, MD, Anna Blask, MD, Judyta
Loomis, MD, Matthew Oetgen, MD; Radiology, Childrens
National Medical Center, Indianapolis, IN
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Congenital anomalies causing lower
extremity shortening can result from dysgenesis or agenesis of
the bones of the thigh, leg or foot; they are generally a very
uncommon occurrence, with an incidence on the order of one
case per 1,000,000 to one case per 100,000 births. These
conditions result in varying degrees of morbidity, ranging from
gait dysfunction to complete lack of the ability to ambulate. The
accurate characterization of such an anomaly may be
challenging prenatally, but can have significant impact on
prognosis and treatment planning.We present a collection of
cases depicting the spectrum of prenatally diagnosed anomalies
of limb development, including proximal focal femoral
deficiency, multiple cases of varying degrees of fibular and
tibial hemimelia, amniotic band syndrome, benign uterine
packing, neurofibromatosis, clubfoot anomaly and rocker
bottom foot, all of which were evaluated on prenatal ultrasound
and/or fetal MRI. Accurate prenatal diagnosis is extremely
important for prognosis, treatment planning and risk-
stratification for associated congenital anomalies. The purpose
of this poster will be to highlight the imaging features by both
fetal MRI and prenatal US, discuss potential diagnostic pitfalls
and review the clinical implications of this interesting spectrum
of congenital disorders. We will describe a methodical approach
to assessment of these patients. Our recommendations include:
prenatal US to include a complete set of bilateral long bone and
foot length measurements; lateral and footprint views of the
fetal foot; views of both tibiae and fibulae bilaterally; views of
the spine and upper extremities, a thorough search for other
abnormalities; fetal MRI for complex cases or when US
findings are limited; and a complete family and maternal
history, including notation of family stature.Examples of the
classic appearance of these conditions will be presented. Several
missed diagnoses and the lessons learned will also be discussed.
Counseling points addressed by the orthopedic surgeon will be
included. Outcome management will be reviewed.
Poster #: EDU-015
Fetal MRI of Multiple Gestations at 3 Tesla: A Double-
Edged Modality
Matthew Bauer, [email protected]; Matthew
Burgess, MD, Mark Heitzmann, DO; Naval Medical Center San
Diego, San Diego, CA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: This educational exhibit will
demonstrate the strengths and weakness of Fetal MRI at 3 Tesla
in the evaluation of multiple gestations.
Methods & Materials: Employing a case series of multiple
gestation pregnancies evaluated via 3 Tesla MRI, this
educational exhibit will highlight the strengths and weaknesses
of imaging obtained at a higher magnetic field strength when
compared the more routinely available 1.5 Tesla field strength.
Findings and pathology will be correlated with prenatal
ultrasounds as well as post-natal imaging as applicable.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S157
Results: Although the superior resolution obtained at higher
field strengths can be advantageous in identifying and further
characterizing fetal pathology, the sequences are more
susceptible to artifact accentuation, particularly dielectric effect
and motion.
Conclusions: The continued advancement of MR imaging
technology has made higher field strength imaging available at a
growing number of medical centers. Although imaging at 3
Tesla affords improved spatial resolution to visualize and define
pathologic entities, the increased prevalence of artifacts at these
higher field strengths, particularly in the setting of multiple
gestations, requires familiarization on the part of both the
technologist and radiologist to ensure diagnostic images are
successfully obtained.
Poster #: EDU-016
Spectrum of Midface Anomalies on Fetal MRI
Arielle VanSyckel, MD, MS, [email protected]; Brandon P.
Brown, MD, MA; Radiology and Radiological Sciences,
Indiana University, Indianapolis, IN
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Midface anomalies in the fetus can
present with a range of severity and corresponding neonatal
morbidity, on a spectrum from cosmetic disturbance to airway
obstruction. Immediate postpartum complications include life-
threatening hypoxia and feeding disturbances. These anomalies
not only present immediate difficulties but also often exist
within a variety of syndromes with long-term consequences,
affecting various organ systems. While screening ultrasound
frequently can identify deviations from normal, fetal MRI may
provide more detailed and high-resolution imaging for the
characterization of midface anomalies and associated prenatal
disease.The identification of facial anomalies in utero should
prompt further investigation for associated abnormalities, and
will also allow for improved prenatal counseling, which can
prepare parents for the immediate postpartum management
including surgical planning and resource allocation. It
furthermore provides a foundation to shape family expectations
and to begin to frame psychosocial support, allowing parents to
engage mentally and emotionally with the medical and surgical
course that awaits.In this presentation, we highlight the normal
fetal midface as seen on MRI at various stages of development,
and outline a systematic approach for evaluation of the fetal
midface structures. Recognition of this typical appearance will
allow the radiologist to identify the range of possible
abnormalities that can occur and which can shape prognosis
when properly identified. Various cases of midface anomalies
will be reviewed and linked to their clinical significance,
including cases with associated intracranial anomalies and
deficiencies in swallowing and respiration.
Poster #: EDU-017
Neuronal migrational anomalies and cortical malformations
in Fetal MRI - Embryological perspective and avoiding
pitfalls
Shankar S. Ganapathy, MD1,
[email protected], Kyle Hunter2, Emily
Janitz1, Gayathri Sreedher1; 1Pediatric Radiology , Akron
Children's Hospital , Akron, OH, 2Aultman Hospital, Canton,
OH
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Neuronal migration and cortical
organization takes place primarily during the second trimester
and early third trimester. Therefore, detection of cortical
malformations and migrational anomalies on a fetal MRI in a
maturing brain is difficult and may not be evident in some
cases, if performed early.Familiarity with normal sulcation
pattern in a fetus at various ages of gestation and a basic
understanding of the embryogenesis of neuronal migration is
essential to be able to make a diagnosis of these entities.Goals
of the exhibit -Understand development of cerebral cortex and
normal fetal MRI appearance at various stages of gestation.-
Using this knowledge, be able to recognize various cortical
malformations in a fetus and provide a comprehensive diagnosis
regarding etiology, whenever feasible or when the appearance is
typical or when there are ancillary findings- Avoid certain
pitfalls and improve accuracy without overcalling or
undercalling migrational anomalies in a fetal MRIOutline of
the exhibitEmbryology of neuronal migration (during second
and third trimesters)Normal sulcation pattern during mid and
late trimestersEtiology of neuronal migration and cortical
malformations-Multifactorial- Infectious- Genetic
mutation/chromosomal- Ischemic insult- Metabolic disorders
like ZellwegerAppearance of various migrational anomalies
and cortical malformations in a fetal brainPolymicrogyria –
subtle and extensive forms, appearance during various stages of
gestation, correlation with post-natal imaging, typical
appearance in certain genetic mutations, TORCH infections
etcSchizencephaly – associations with absence of septum
pellucidum and other abnormalitiesGray matter heterotopia –
How to differentiate from subependymal nodules and
hemorrhage?Lissencephaly – How to identify a true
lissencephaly/pachygyria in a developing brain with immature
sulcal pattern?Hemimegalencephaly, Microcephaly with
simplified gyral pattern and other cortical malformations.
Evolution of cortical malformations on imaging-Comparison
between early and late gestation fetal MRIs in the same patient
when available- Prenatal and post-natal MRI correlation of
migrational anomalies, when availableAncillary CNS and extra-
CNS abnormalities identified in fetuses with migrational
anomaliesPitfalls and false positive/ false negative cases and
how to avoid them.
Poster #: EDU-018
Radiological findings in nutritional deficiencies and eating
disorders in children: A pictorial review
Christian A. Barrera, M.D., [email protected];
Savvas Andronikou, MBBCh, FCRad, FRCR, PhD (UCT), PhD
(Wits), Hansel J. Otero, MD; The Children's Hospital of
Philadelphia, Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Nutritional deficiencies in children
are prevalent both in the US and abroad often under-diagnosed
unless symptomatic. Some nutritional deficiencies have
conspicuous imaging findings that might help with diagnosis
and/or follow up in a timely manner. Similarly, imaging might
be needed to diagnose or follow complications related to
malnutrition and eating disorders such as bulimia, anorexia
nervosa, binge eating and pica. This educational exhibit will
review radiographic, CT and MR imaging of nutritional
deficiencies and complications of malnutrition and eating
disorders in children
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S158
Poster #: EDU-019
Pediatric Emergency Gastrointestinal Ultrasonography:
Pearls and Pitfalls
Moshe Meister, MD1, [email protected]; Jane Kim,
MD2, Jennifer K. Son2; 1University of Maryland Medical
Center, Baltimore, MD, 2University of Maryland School of
Medicine, Baltimore, MD
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Ultrasonography (US) is an essential
tool in pediatric imaging, particularly in the emergency setting.
Although US is often the favored initial modality for abdominal
imaging in children, it is a highly operator-dependent modality
prone to misinterpretation which can lead to false positive or
negative exams, or even a different, incorrect diagnosis.
Conditions discussed in this series include ileocolic
intussusception, hypertrophic pyloric stenosis, appendicitis, and
foreign bodies. We will review diagnostic criteria, highlight
crucial findings, as well as illustrate commonly-encountered
difficulties and mimics.
Poster #: EDU-020
Do we need to differentiate between different types of
intestinal rotational abnormalities in asymptomatic
children?
Boaz Karmazyn, MD, [email protected]; Megan B.
Marine, MD, Matthew R. Wanner, Deborah Billmire, MD;
Indiana University School of Medicine, Riley Hospital for
Children, Indianapolis, IN
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Intestinal rotation abnormality (IRA)
can lead to catastrophic events from midgut volvulus. In a child
that presents with bilious vomiting, urgent surgery should be
performed. Ladd’s surgery is associated with complications in
10% to 20% of the patients. In this review we will show that in
selected asymptomatic children with IRA, imaging can help
decide if observation should be considered rather than surgery.
Methods & Materials: We reviewed upper gastrointestinal
contrast studies, small bowel follow through contrast studies
(SBFT), and colon enemas of children with a diagnosis of IRA
who had surgery. We evaluated location of the duodenal jejunal
junction (DJJ), position of the duodenum in the lateral view, and
the anatomy of the colon. Location of the DJJ to the right of the
left pedicle on the anterioposterior view or anterior in the lateral
view was defined as IRA. We evaluated three types of IRA
based on current literature: nonrotation (entire colon in the left
abdomen, cecum in the left lower quadrant and the small bowel
in the right abdomen), atypical malrotation (DJJ between
midline and left pedicle), and typical malrotation (IRA that
cannot be defined as nonrotation or atypical malrotation).
Results: We will present an imaging algorithm for evaluation of
malrotation and show imaging findings of all types of IRA as
well as challenging cases. We will show cases with nonrotation
when there was no need for surgery and other cases when Ladd
bands were found. We will show cases of atypical malrotation.
We found that if the duodenum is posterior and the entire colon
is normal, the mesenteric root is broad and there is no need for
surgery. We will also show indeterminate cases, when
laparoscopy was necessary.We will show how anatomy of the
colon helps to define the types of IRA. We will show cases
where SBFT did not demonstrate the entire colon and was
misleading. Enema should, therefore, be considered to evaluate
the anatomy of the colon for definitive diagnosis.
Conclusions: We suggest considering a more stringent
definition of atypical malrotation when there is also posterior
position of the duodenum and normal colon. In asymptomatic
children, especially at older ages, findings of nonrotation or
atypical malrotation can provide an option for observation
rather than surgery.
Poster #: EDU-021
Eovist in Pediatric MR: What Can and Can't It Do?
Narendra S. Shet, MD1, [email protected]; John F.
Flynn, MD1, Ezekiel Maloney, MD2, Ramesh Iyer, MD2; 1Children's National Medical Center, Washington, DC, 2Seattle
Children's Hospital, Seattle, WA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: The purpose of this review is to
provide an overview of applications of Eovist in the pediatric
population, as well as pitfalls. We will begin with an
introduction on the origins of Eovist and how it and other
hepatocyte specific contrast agents (HSCAs) differ from
conventional gadolinium based contrast agents (GBCAs). We
will then provide a sample of imaging protocols when Eovist is
used for hepatic mass evaluation and for biliary indications. We
will review benefits of Eovist in characterizing a variety of
pediatric hepatic neoplasms, including hepatoblastoma,
hepatocellular carcinoma, focal nodular hyperplasia, hepatic
adenomas, and regenerative nodules, with mention of
pathologies that do not follow traditional patterns (i.e.,
inflammatory adenomas). After this, we will cover biliary
applications, including choledochal cysts, biliary obstruction,
and postoperative bile leak. Finally, we will review some
limitations of Eovist; notably, we will mention several scenarios
where the hepatobiliary phase could not be achieved, and
recommendations for how to approach these cases.
Poster #: EDU-022
Mimics of appendicitis on pediatric appendicitis protocol
MRI
Ryne Dougherty, M.D. M.B.A., [email protected];
Timothy Alves, MD; University of Michigan, Ann Arbor, MI
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Abdominal pain is common
presentation to the pediatric emergency department, and
appendicitis remains the most common pediatric surgical
emergency. While the imaging workup of pediatric appendicitis
typically begins with ultrasound, MRI is increasingly being used
for problem-solving and to further evaluate equivocal
ultrasound results. With increased utilization, more and more
mimics of appendicitis are being encountered on MRI. The
purpose of this educational exhibit is to familiarize the
practicing pediatric radiologist with these mimics through a
case-based review in order to improve diagnostic accuracy and
patient care.
Methods & Materials: We will present a series of common and
uncommon mimics of appendicitis on MRI in the pediatric
patient based on over 5 years of experience with limited
pediatric protocol MRI for appendicitis. While the exhibit will
focus on MRI findings, correlative US and CT findings will be
included.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S159
Results: This case-based educational exhibit will cover multiple
mimics of appendicitis encountered in clinical practice,
including but not limited to: omental infarct, Meckel’s
diverticulitis, pyelonephritis, ovarian torsion, tubo-ovarian
abscess, isolated fallopian tube torsion, intussusception, and
psoas myositis.
Conclusions: Abdominal pain with concern for appendicitis is a
common pediatric clinical presentation which relies heavily on
imaging for diagnosis. The utilization of MRI for the evaluation
of possible appendicitis continues to rise, and familiarity with
common and uncommon mimics of appendicitis which may be
encountered on MRI will help the practicing pediatric
radiologist with interpretation of these studies and improve
patient care.
Poster #: EDU-023
Radiologic Manifestations of Epidermolysis Bullosa
Samar Sheriff, MBA, [email protected]; Anne Lucky,
MD, Niekoo Abbasian, MD, Alexander J. Towbin, MD;
Cincinnati Children's Hospital Medical Center, Cincinnati, OH
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Epidermolysis bullosa (EB) is a
group of rare genetic disorders that arise from at least 19 gene
mutations for proteins that are involved in skin integrity. EB
affects 1 out of 20,000 births in the United States and results in
fragile skin that easily blisters from any minor friction or
mechanical trauma. Other organ systems can also be seriously
affected. The chronic skin inflammation and infections also
places patients at risk for developing squamous cell carcinoma.
Unfortunately, there is currently no cure for EB. The standard of
care is supportive therapy and includes daily wound care,
specialized dressings, and pain control.Because of the wide
spectrum of systemic symptoms, there are numerous imaging
findings that can be seen in patients with EB. These radiologic
features can be categorized by body system including: 1)
cardiac; 2) respiratory; 3) gastrointestinal; 4) genitourinary; 5)
musculoskeletal; and 6) prenatal/fetal.There are various
precautions that must be taken when performing any type of
imaging study or anesthetic procedure for a patient with EB.
These include but are not limited to: avoiding adhesives on the
skin, providing special care when moving a patient, supporting
pressure points on the imaging table, using large amounts of
sterile water-based gel for ultrasound probes, and taking special
care to protect the patient’s skin, airway and oral cavity during
anesthesia or sedation events.The purpose of this poster is to: 1)
review the various clinical presentations, pathologies, and
associated imaging findings involved in EB, 2) examine
imaging and anesthetic concerns when dealing with patients
with EB, and 3) discuss the imaging and anesthesia approach
used when evaluating EB patients.
Poster #: EDU-024
Pediatric total pancreatectomy and islet autotransplant: an
introduction for the radiologist
John J. Groene, MD, [email protected]; Minna M.
Wieck, MD, Seng Ong, Mario F. Zaritzky, MD, Kate A.
Feinstein; Radiology, University of Chicago, Chicago, IL
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: In this exhibit we will describe a
fairly new surgical procedure - total pancreatectomy and islet
autotransplant (TPIAT). TPIAT is an uncommon procedure
performed in children who suffer from chronic or recurrent
acute pancreatitis. The purpose of the exhibit is to learn about
the selection criteria, the surgery itself, and the imaging features
of surgical complications. Candidates are selected for surgery
based on a multitude of factors including severity and chronicity
of pain, laboratory evaluation of pancreatic exocrine and
endocrine function, and imaging features of chronic pancreatitis
on MRCP and/or endoscopic ultrasound. In the surgical
procedure, the pancreas and duodenum are resected, islet cells
are isolated and then infused through the portal vein into the
liver. A splenectomy is performed and continuity of the GI tract
restored. Patients may spend three weeks in the hospital after
surgery. Months after the infusion, the islet cells will be
embedded within the liver and begin to produce insulin. The
primary goal of this procedure is to relieve debilitating pain and
improve quality of life, for which this procedure is around 90%
successful. The secondary goal of the procedure is to retain islet
cell function. In this regard, approximately 40% of the pediatric
patients will regain complete islet cell function, 30% will regain
partial function while 30% will have no islet cell function.
Follow up imaging may also be performed on these patients for
evaluation of complications such as delayed gastric emptying,
small bowel obstruction, surgical site infections, bile leak, and
intra-abdominal hemorrhage. Complications seen in our
hospital, including small bowel obstruction, delayed gastric
emptying, and prolonged ileus will be highlighted.
Poster #: EDU-025
Is the new ultrasound technology affecting the way
radiologists are interpreting studies for Hypertrophic
Pyloric Stenosis?
Juan S. Calle Toro, MD, [email protected]; Savvas
Andronikou, MBBCh, FCRad, FRCR, PhD (UCT), PhD
(Wits); Radiology, Children’s Hospital of Philadelphia,
Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To retrospectively review the
imaging planes performed, the number pyloric layers visible and
the location of measurements taken, in infants with suspected
(HPS).
Methods & Materials: 103 pyloric ultrasound studies referred
for suspected HPS were included. One pediatric radiologist with
20 years of experience and one medical doctor reviewed the
studies. For each individual study, it was recorded whether
longitudinal or transverse views were performed, the layers that
could be visualised. A schematic was developed to categorise
the interfaces of the anatomic layers of the pylorus visualised
and position of the internal measurement cursor. Categories for
the anterior wall were: a deep aspect of the muscularis propria;
b superficial aspect of the muscularis mucosa; c deep aspect of
the muscularis mucosa; d superficial aspect of the mucosa
interfacing with the muscularis mucosa from a mucosal fold; e
deep aspect of the muscularis mucosa from a mucosal fold.
Categories for the posterior wall were: 1 deep aspect of the
muscularis propria; 2 superficial aspect of the muscularis
mucosa; 3 deep aspect of the muscularis mucosa; 4 deep aspect
of the mucosa interfacing with muscularis mucosa from a
mucosal fold; 5 deep aspect of the muscularis mucosa from a
mucosal fold. Descriptive analysis was made for the categorical
variables using STATA 15 software.
Results: A total of 100 studies (97 patients) were reviewed.
Studies recorded longitudinal (99%) and transverse (69%) views
of the pylorus. For the longitudinal view, measurements
included muscle thickness in 95%, length in 97% and 0% for
the pyloric diameter. For the transverse view, measurements
included muscle thickness in 16% and the diameter in 3%.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S160
Pyloric layer interfaces (as defined above) were visible as
follows: a in 64%, b in 64%, c in 66%, d in 30% and e in 26%.
The internal (deep) reference point of cursor placement for
measuring the muscle wall thickness in the longitudinal view
was as follows: a in 46%, b in 27%, c in 30%, d in 1% and e in
2% of the studies.
Conclusions: New US technology provides more detailed
anatomy and this affects measurements for muscle wall
thickness. Considering that a millimetre can make a
measurement fall into the abnormal category resulting in
surgical treatment such differences in practice must be
highlighted and recommendations need to be clarified. We
believe that the largely abandoned diameter measurement, in the
transverse or longitudinal views, may offer a solution as it is not
defined by any internal layers.
Poster #: EDU-026
Optimizing Your Evaluation of Contrast Enemas for Distal
Bowel Obstruction in Neonates: Protocol, Technique,
Imaging Findings and Differential Diagnoses
Austin Dillard, MD, [email protected]; Steve Kraus,
MD; Cincinnati Childrens, Cincinnati, OH
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Bowel obstruction in the neonate is
common. When neonatal intestinal obstruction is suspected,
initial workup may include abdominal radiographs or
ultrasound; however, in most busy pediatric radiology practices
fluoroscopy is indicated to diagnose the cause, which helps the
surgeon make management decisions. Accurate diagnosis is key
to the successful management of these neonates. The
fluoroscopist should be mindful of the methods and techniques
which make evaluation of distal bowel obstruction
straightforward and efficient. This exhibit will detail the
rationale and protocol to perform the optimal contrast enema,
which is essential to have a chance to reliably distinguish the
several causes of distal bowel obstruction in neonates. Will
include examples with imaging findings and differential
diagnoses.
Poster #: EDU-027
Traumatic Handlebar Injuries
Joseph McCrary, MD, [email protected]; Jennifer
Talmadge, MD; Maine Medical Center, Portland, ME
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Direct impact upon the bicycle
handlebars is an especially harmful mechanism of injury in
children. Pediatric patients who present following direct impact
of the bicycle handlebars upon the abdomen are much more
likely to suffer internal organ injury and require operative
intervention than those who present following a bicycle accident
without direct impact upon the handlebars.Unfortunately,
bicycle handlebar trauma is not only a damaging mechanism of
injury, but also a treacherous one. Physical exam findings can
be subtle; these children often appear misleadingly well. Many
such children are initially misdiagnosed and sent home
prematurely only to re-present. Delays in definitive diagnosis
are typical.The radiologist, therefore, by aiding in the timely
identification of injuries and determination of any need for
surgery, can make a valuable contribution to patient care.Our
cases include a 9-year-old girl with a puncture wound and
abscess in the medial thigh musculature, a 13-year-old male
with a penetrating wound to the left lower abdominal quadrant
with extensive retroperitoneal and extraperitoneal hematoma
and other injuries, a 14-year-old male with a hematoma in the
right lower abdominal quadrant, and a 7-year-old boy with a
liver laceration, each of whom suffered a bicycle handlebar
impact to the abdomen.As companion cases, we also present a
12-year-old boy with a transected pancreas following an ATV
rollover which involved impact of the handlebars upon the
abdomen, and a 49-year-old man who sustained a shattered
kidney in a bicycle accident.
Poster #: EDU-028
Acute, emergent and post-surgical disorders involving the
pediatric jejunum.
Deborah Brahee, [email protected]; Alexander J.
Towbin, MD; Cincinnati Children’s Hospital Medical Center,
Cincinnati, OH
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Pediatric pathology involving the
jejunum is more common than one might initially expect. Early
recognition of the important imaging characteristic, atypical
findings, and useful imaging tools/techniques in the evaluation
of jejunal pathology is important in prompt diagnosis and
management of these patients.In this educational exhibit we will
present a series of cases involving pathology of the jejunum
encountered in the pediatric population. We will focus on
important pathologies affecting a difficult to image and
sometimes forgotten portion of the intestine.A range of acute,
emergent and post-surgical cases are presented. Using an
interactive, quiz based approach we will discuss the following
pediatric pathologies that may affect the jejunum of pediatric
patients from neonates to teenagers with multimodality imaging
and pathologic examples:AtresiaMeconium plug
syndromePneumatosisEnteritisForeign bodySmall bowel
intussusceptionLymphomaIschemia/shockHerniaGraft versus
host diseaseTraumaVasculitis
Poster #: EDU-029
The Belly Button: Imaging of Pediatric Umbilical Disorders
Arushi Devgan, MD, [email protected]; Amy Rowell,
MD; Diagnostic Radiology, University of Arkansas for Medical
Sciences (UAMS), Little Rock, AR
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: This poster aims to educate about the
radiographic findings of pediatric umbilical disorders by
presenting a case series, and to correlate the pathology with
embryogenesis.
Methods & Materials: A retrospective review of our database
was performed to select cases of umbilical disorders in children
that required imaging. Imaging findings, pathological reports,
and electronic medical records of these cases were reviewed.
Results: Radiographic, surgical, and pathologic findings of 6
cases of pediatric umbilical disorders were reviewed from our
database. Patient age ranged from 10 weeks to 11 years old. The
cases included patent omphalomesenteric duct, infected urachal
cyst, patent urachus, and Meckel’s diverticulum.
Conclusions: Umbilical disorders are classified according to
embryonic remnants in the umbilicus and its associations with
the urinary bladder and the bowel, which is why imaging can be
useful in understanding the anatomy and differential diagnoses
in such cases. These abnormalities can also have nonspecific
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S161
clinical manifestations. Therefore, imaging can help in
identifying and correctly diagnosing umbilical disorders, which
is key to appropriate and timely patient management.
Poster #: EDU-030
Pediatric Spleen: Anatomic Variants and Pathology
James Davis, [email protected]; Kathleen Gebarski, Peter
Strouse; University of Michigan, Ann Arbor, MI
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: While the most common
abnormalities of the spleen are splenomegaly and trauma, many
additional disease states can be manifested in the spleen which
should be considered when evaluating the abdomen on cross
sectional imaging. We composed a pictorial guide of a wide
variety of variants and diseases for education and reference.
Methods & Materials: Illustrative cases of congenital,
developmental, infectious, and neoplastic processes involving
the spleen were chosen from the last fifteen years of abdominal
sonography at our institution along with CT, MRI and
pathologic correlation. Case examples include polysplenia,
storage diseases, wandering spleen, torsed spleen, various cysts,
siderotic nodules, splenic complications of sickle cell disease
including autolysis, islands of residual splenic tissue and
echogenic foci, hamartoma, various infections, hemangioma,
and infiltrative diseases such as leukemia and lymphoma.
Results: Reviewing these cases provides an experience of a
wide variety of splenic anatomic variants and pathology and
improves the accuracy of interpretation.
Conclusions: A pictorial review of a wide variety of splenic
anatomy and pathology improves the accuracy of interpretation.
Poster #: EDU-031
Imaging Findings and Clinical Manifestations of Pancreatic
Neoplasms in Children
Reem Haswegh, [email protected]; Andrew T. Trout,
Alexander J. Towbin, MD; Department of Radiology,
Cincinnati Children’s Hospital Medical Center Cincinnati, OH
Disclosures: Andrew T. Trout, MD: Consultant, Honoraria:
Guerbet Group, Royalty: Elsevier, Wolters-Kluwer, Research
Grants: Canon Medical, Siemens Medical Solutions, National
Pancreas Foundation, In-Kind Support: ChiRhoClin Inc.,
Perspectum Diagnostics. All other authors have disclosed no
financial interests, arrangements or affiliations in the context of
this activity.
Purpose or Case Report: Pancreatic neoplasms are rare in
children and young adults, with an incidence of 0.46 per million
under 30 years of age. Fortunately, children with a pancreatic
neoplasm have a better prognosis than adults. The better
prognosis and rarity of disease both contribute to the fact that
pancreatic malignancies account for less than 0.2% of cancer-
related deaths.Ultrasound is often the initial imaging modality to
identify a pancreatic neoplasm due to its use for evaluation of
symptoms such as upper abdominal pain, a palpable epigastric
mass, or jaundice. Known pancreatic masses, or those detected
initially by ultrasound should be imaged with CT or MRI to best
characterize the mass and its relationship to adjacent structures,
particularly the vasculature. Nuclear medicine plays a role in
imaging of some pancreatic neoplasms depending on
histology.Once a pancreatic neoplasm is identified, the
radiologist is tasked with making a diagnosis from a differential
diagnosis list of rare tumors. Primary pancreatic neoplasms are
divided into epithelial and nonepithelial types. The epithelial
tumors are more common and may be further subdivided into
exocrine or endocrine subtypes. Epithelial exocrine tumors are
the most common in children. Examples of these tumors include
the two most common pediatric pancreatic neoplasms
pancreatoblastoma and solid-pseudopapillary neoplasms.
Endocrine tumors are uncommon. While functioning endocrine
tumors can occur, non-functioning tumors are more common
and are associated with syndromes such as von Hippel Lindau,
multiple endocrine neoplasia type 1, and tuberous sclerosis.
Nonepithelial tumors are also rare and include a number of
different entities such as lymphoma, neurofibroma, and
teratomas. Finally, the pancreas is an extremely rare site of
metastasis. Pancreatic metastases can occur with multiple
primary malignancies including neuroblastoma,
rhabdomyosarcoma, and osteosarcoma.This exhibit will
describe the imaging work-up of pancreatic tumors in children.
We will illustrate the different clinical manifestations and
imaging appearances of the various pediatric pancreatic
neoplasms.
Poster #: EDU-032
To Spleen, with Love
Anne K. Misiura, MD, [email protected]; Jacqueline
Urbine, MD, Erica Poletto, MD, Archana Malik, MD, Mea
Mallon; Radiology, St. Christopher's Hospital for Children,
Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: The spleen is rarely the first organ to
come to mind in discussing pathology of the abdomen, and
indeed may often be the last. However, there are a multitude of
splenic processes and abnormalities that should be kept in mind
when discussing the pediatric abdomen. Additionally, splenic
abnormalities, or lack thereof, can also be clues to diagnosis in
more difficult cases.
Methods & Materials: A retrospective analysis of
multimodality imaging in pediatric patients demonstrating
splenic imaging abnormalities, who presented to an urban
children’s hospital since 2005 is performed. Imaging and
clinical history are correlated with laboratory findings where
applicable. A variety of splenic abnormalities are selected for
imaging review.
Results: Review of splenic abnormalities is provided with
imaging examples. Examples include metabolic, malignancy,
trauma, and other disorders, including, but not limited to
abnormalities in splenic size, cystic and solid splenic lesions,
infiltrative/consumptive processes, and situs disorders.
Conclusions: The spleen is often the forgotten organ of the
pediatric abdomen, but there are many exciting things to be
found in the left upper quadrant. Clinicians and pediatric
radiologists alike should not disregard the spleen in abdominal
cases, for there are many pathologies and clues to be found.
Poster #: EDU-033
Spectrum of imaging abnormalities in patients with eating
disorders in the pediatric population
Karuna Shekdar, MD, [email protected]; Sudha
Anupindi, MD, Janet R. Reid, MD, FRCPC; Radiology,
Children's Hospital of Philadelphia, Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S162
Purpose or Case Report: To describe the spectrum of imaging
abnormalities seen in eating disorders such as anorexia nervosa
in the pediatric population.
Methods & Materials: Patients who were diagnosed with
anorexia nervosa and had imaging studies for indications related
to their eating disorder at our institution were included in this
review. The imaging studies reviewed included chest, abdomen
and pelvis radiographs, fluoroscopy studies of the upper
gastrointestinal tract, studies, ultrasound studies of the
abdomen, Computed Tomography of the brain, abdomen and
pelvis and Magnetic resonance imaging studies of the brain.
Results: A variety of imaging findings were identified in these
patients including mild morphological findings to sequelae of
multi-organ failure which will be illustrated with case examples
on this review.
Conclusions: Eating disorders can affect multiple organ
systems with a spectrum of morbidity. Eating disorders manifest
usually in teen age females and can be challenging to diagnose.
Awareness among pediatric radiologists about imaging findings
in eating disorders is crucial to the diagnosis and management.
Poster #: EDU-034
Where are We Exactly?: Navigating the Complex Roadmap
of Müllerian Duct Anomalies
Ross A. Myers, MD1, [email protected]; Tianyang
Li, MD1, Jennifer Wu, MD1, David Sadowsky, MD1, Mary Paul,
MS42, Perry Gerard, MD1, Adele Brudnicki, MD1, Lesli
LeCompte, MD1; 1Westchester Medical Center, Valhalla,
NY, 2New York Medical College, Valhalla, NY
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Müllerian Duct Anomalies (MDA)
are a broad category of congenital deformities of the urogenital
structures due to abnormal development, fusion, or resorption of
the fetal Müllerian Ducts. By definition, the Müllerian Ducts are
the paired fetal structures that are located medially to the
Wolffian Ducts and develop into the Fallopian Tubes, uterus,
cervix, and upper two-thirds of the vagina. The multitude of
symptoms associated with MDAs vary broadly in severity,
ranging from patients with no symptoms and incidentally
discovered MDAs to patients with primary infertility, recurrent
pregnancy loss and other reproductive problems.There are well
documented associations of MDAs with other genitourinary
malformations. The most commonly reported is renal agenesis,
which accounts for up to 30% of all associated renal anomalies
in the setting of MDA, however abnormalities including ureteral
remnants with ectopic insertion or collecting system duplication
have been reported as well. The overall incidence of MDAs
varies, but have been estimated to be approximately 1-5%
within the general population and up to 13-25% in patients with
recurrent pregnancy loss.The most commonly accepted system
of classification of the various types of MDAs is that of the
American Fertility Society, which divides MDAs into seven
categories. However, there is often confusion as to how to
categorize MDAs demonstrating characteristics of more than
one class. Medical imaging is of essential importance for both
this reason and for appropriate planning of therapy. The
imaging of suspected MDAs involves the implementation of a
combination of 3D Ultrasound, Magnetic Resonance Imaging,
Sonohysterography, Hysterosalpingraphy and/or laparoscopy.
Sonography and MRI have the benefits of being the least
invasive methods of diagnosis.The goal of our educational
exhibit will provide an overview of the embryology and
pathophysiology related to a broad variety Müllerian Duct
Anomalies. We will discuss the common imaging techniques
employed in the workup of patients with Müllerian Anomalies.
In addition, we provide a plethora of interesting cases from our
home institution including a case of Mayer-Rokitansky-Küster-
Hauser Syndrome, Obstructed Hemivagina and Ipsilateral Renal
Anomaly (OHVIRA), cloacal abnormality, bicornuate uterus
and other complex cases utilizing a variety of imaging
modalities.
Poster #: EDU-035
Rapid MRI as accurate one-stop imaging for adnexal
torsion
S Pinar Karakas, MD1, [email protected]; Unni
K. Udayasankar, MD, FRCR2, Ellen S Park3, Bamidele
Kammen1, Wendy Su1, Sunghoon Kim1, Thomas Hui1, Taylor
Chung, MD1; 1Pediatric Radiology, Benioff Children's Hospital
at Oakland, CA, Oakland, CA, 2university of Arizona, Tuscon,
AZ, 3Cleveland Clinic, Cleveland, OH
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Adnexal torsion is a common
emergency room query in young girls and teenagers presenting
with pelvic pain. It is a consequence of an underlying adnexal
lesion or to anatomical laxity of the suspensory/anchoring
ligaments. Clinical symptoms at presentation can be confusing
and nonspecific, yet prompt diagnosis and surgical intervention
are essential to save the adnexa. Radiology plays a crucial role
in the diagnosis of adnexal torsion. Our exhibit will review and
promote the rapid MRI as the first line, one-stop imaging in the
diagnosis of adnexal torsion and other causes of pelvic pain.
Some cases will be presented with initial ultrasound images and
demonstrate how MRI increased the confidence in the
diagnosis. All presented cases have pathology correlation and or
operative reports and follow-up imaging. We will show various
cases of ovarian and tubal torsions and their mimickers. In
particular, we include torsions due to anatomical laxity of the
suspensory ligaments, resulting from tubo-ovarian cysts and
solid adnexal masses as well as cases of isolated tubal
torsions.Table of Contents/Outline:Review of the embryology
and anatomy of adnexa including suspensory/ anchoring
ligaments.Review pathophysiology and progression of ovarian
torsionReview rapid motion insensitive high-resolution MRI
protocol for adnexal torsionReview hallmark imaging findings
of adnexal torsion with MRI (with accompanying ultrasound
comparison in some cases)Review MRI findings of adnexal
viability and demiseReview multiple MRI examples of adnexal
torsion and its mimickers
Poster #: EDU-036
Twisted Pelvic Pathology: Overview of pelvic torsions in the
pediatric population
Brianna Oliver,[email protected]; Radiology,
University of Michigan, Ann Arbor, MI
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Pelvic and scrotal pain are common
emergent presenting symptoms in the pediatric population, and
these patients are commonly imaged to evaluated for gonadal
torsion. In this educational exhibit we will review the entire
spectrum of gonadal and paragonadal torsions in the pediatric
population, focusing on clinical presentations, key imaging
findings, possible pitfalls in diagnosis, and next steps in
management. It is essential for the pediatric radiologist to be
familiar with this range of pathology in order to render an
accurate and timely diagnosis, particularly given that some (but
not all) of these diagnoses require emergent surgery.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S163
Methods & Materials: Illustrative cases of gonadal and
paragonadal torsions were selected from the past 5 years at our
tertiary-case academic medical center with a dedicated pediatric
hospital. Cases include, but are not limited to, the spectrum of
ovarian torsion (from subtle findings of torsion in a previously
normal ovary to cases of ovarian torsion with an underlying
mass), the spectrum of testicular torsion (from a twisted
spermatic cord with preserved testicular flow to more severe
torsion with testicular infarction), isolated fallopian tube torsion,
paratubal cyst torsion, and paratesticular appendage torsion.
Results: A case-based review of pediatric pelvic (gonadal and
paragonadal) torsions covering the entire range of presentation
of common entities and classic presentations of rare entities will
allow the pediatric radiologist to become more confident and
competent in the interpretation of ultrasonography performed
for these indications, and well as the interpretation of MRI
performed for problem-solving.
Conclusions: Suspected gonadal and paragonadal torsions are
relatively common indications for imaging, particularly
ultrasonography, in the pediatric population. Familiarity with
these entities and the entire spectrum of imaging findings will
improve diagnostic accuracy and efficiency of interpretation.
This is extremely important as the pediatric radiologist plays a
key role in making the ultimate diagnosis and distinguishing
surgical emergencies from benign self-limited conditions.
Poster #: EDU-037
Pediatric urodynamics: a radiologist’s primer
Emily Sellers, MD, [email protected]; Katherine
L. Stahoviak, Seng Ong, MD, Kate A. Feinstein, MD;
Radiology, University of Chicago, Chicago , IL
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: In this exhibit, we will describe the
synergistic effect of urodynamics and imaging. Bladder
dysfunction, a common problem in children, accounts for up to
40 percent of pediatric urology clinic visits. Urodynamics is a
key study to determine the etiology of bladder dysfunction yet,
many radiologists are unfamiliar with this exam. Urodynamics
is a fluoroscopic evaluation of the bladder with contrast during
which abdominal and bladder pressures are measured while the
bladder fills and empties. It uses a combination of
electromyogram to evaluate pelvic floor contractions,
cystometrogram to evaluate bladder pressures and capacity, and
voiding cystourethrography to evaluate lower urinary tract
anatomy. This exhibit will explain the indications for
urodynamics, the basics of its interpretation including detrusor
function and pressure flow studies, and the types of pathologies
which may be diagnosed. Neurogenic bladder, congenital
abnormalities, and how to differentiate between subsets of
overactive bladder and underactive bladder will be explained.
We will show imaging findings which correlate with these
urodynamic diagnoses and describe ways to enhance voiding
cystourethrograms and sonograms to better evaluate children
with lower urinary tract dysfunction.
Poster #: EDU-038
Implementing a contrast enhanced Voiding
Ultrasonography (ceVUS) Program at a Large Children’s
Hospital: How our experience can help you
Kate Louise M. Mangona, MD,
[email protected]; Matthew R.
Hammer, MD, Jeannie Kwon, MD; UTSW/ Children's Health,
Dallas, TX
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Voiding cystourethrography (VCUG)
has long been utilized in the diagnosis of vesicoureteral reflux
in children with urinary tract infections. Sonographic techniques
have been developed to make the same diagnosis without
exposing the child to ionizing radiation. This presentation
describes the implementation steps of a new service including:
pharmacy approval and formulary addition; sonographer
training and coordination with fluoroscopy technologists;
referring clinician education and outreach. This exhibit educates
the reader on how ceVUS can be performed, how it can be
established at a children’s hospital, and the benefits it
provides.Correct technique and acquisition of images is shown
using clinical case examples. Relevant anatomy is reviewed.
Correlation of ultrasound abnormalities with VCUG results is
provided. The process of training technologists and radiologists
is highlighted. Pitfalls and tips to improve imaging are
described. We will present results on how our new service has
been accepted and utilized by the urologists and referring
physicians. We have now performed over 50 ceVUS studies this
year.
Poster #: EDU-039: Withdrawn
Poster #: EDU-040
A Customized Virtual Reality Experience for Simulating
Magnetic Resonance Imaging Exams
Yungui Huang, PhD, [email protected];
John Luna, Ramkumar Krishnamurthy, PhD, Lacey J. Lubeley,
BS, Tricia Buskirk, Master of Science in Child and Family
Studies, Arleen Karczewski, Whitney Garrett, Simon Lin,
MD, Aaron S. McAllister, MD, Rajesh Krishnamurthy,
Houchun Hu, PhD; Nationwide Children's Hospital, Columbus,
OH
Disclosures: Aaron S. McAllister, MD: Equity Interest/Stock
Option: GE, MMM, CHD, JNJ. All other authors have disclosed
no financial interests, arrangements or affiliations in the context
of this activity.
Purpose or Case Report: Background: Image quality in MRI
is often degraded by patient motion. To reduce the need for
repeat exams, sedation or general anesthesia is used in pediatric
patients. This requires additional clinical staff, and leads to
increased scheduling wait times and overall procedure times
that impact workflow. Many institutions prepare children for
MRI using mock-up replicas. While effective in acclimating
patients to the MRI environment, the availability of mock-up
practices are often limited. Mock-ups also require physical
space and do not simulate the full MRI environment and exam
experience.Purpose: We build an affordable, scalable, and
portable immersive virtual reality (IVR) platform for simulating
MRI exams. Specifically, we designed an IVR environment that
accurately mimics a Siemens 3 Tesla suite within our Radiology
practice, including intricate details such as room size, color,
lighting, ancillary equipment, pulse sequence audio, and
background noise. The IVR platform also attempts to simulate
the complete sequence of events and environments a child will
experience during an exam, including the check-in process,
interactions with staff (e.g., nurses, technologists), the waiting
area and changing rooms, the positioning and motion of the
MRI table, placement of coils, and within-exam instructions,
such as breath-holds. Our platform also allows the patient to
move around in the VR space and interact with the environment.
Additionally, the platform can be easily converted to mimic any
other MR suite. We hypothesize that our platform can be easily
adopted by Child Life and hospital staff to quickly acclimate a
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S164
patient and assess whether he/she can suitably undergo an MRI
exam without sedation or general anesthesia.We believe the
IVR platform can overcome the limitations of mock-up replicas.
First, IVR has a smaller footprint and is scalable and portable
across the hospital. This allows multiple IVR sessions to be held
in parallel. Second, IVR can give the patient a hospital-specific
and scan-specific first-person experience. The patient can
interact with realistic 3D representations of the MRI
environment and processes. Our current implementation of IVR
was developed using HTC VIVE headsets with a dedicated
laptop for control. To further improve portability, the IVR setup
can be adopted using simple goggles and handheld devices. This
will enable future IVR sessions to be conducted at the bedside,
in patient’s homes, and in referring physician offices.:
Poster #: EDU-041
Speeding Up Pediatric MRI: Making Sense of the Alphabet
Soup of Acceleration Techniques
Eric Loken, Joo Cho, David Bessom, Frank Corwin, Brent
Metts, Gregory Vorona, MD, [email protected];
Radiology , Virginia Commonwealth University , Richmond,
VA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Magnetic resonance imaging (MRI)
is a robust imaging modality. However, the necessity for
patients to hold still commonly requires pediatric patients to be
sedated (which carries its own risks), or limits the useful scan
time window in some nonsedated pediatric patients. In some
circumstances, there is no way to control the movement of the
imaging target (i.e. fetal MRI).MRI is also very customizable,
and there are number of options currently available to accelerate
MR imaging. It is important for pediatric radiologists
supervising pediatric MRI examinations to have a broad
understanding of the technology that is currently available, in
order to optimize imaging quality and mitigate sedation use.In
this educational exhibit, we will briefly review a number of
acceleration techniques available on the Siemens platform,
noting that other vendors have very similar options available for
their customers. These techniques will include single-shot fast
spin echo , balanced steady-state gradient echo, parallel
imaging, radial imaging, and simultaneous multislice imaging.
Our review will focus on the relative advantages and
disadvantages of these techniques, rather than on the physics of
image generation.
Poster #: EDU-042
Creation of a Multi-Institutional Registry Framework
Erin Payne, BSN1, [email protected]; Juan S. Martin-Saavedra,
MD2, Teresa Victoria, MD, PhD2, Amie L. Robinson,
BSRT(R)(MR)1, Kristin Fickenscher, MD1, Sherwin S. Chan,
MD PhD1; 1Radiology, Children's Mercy Hospital, Kansas City,
MO, 2Children's Hospital of Philadelphia, Philadelphia, PA
Disclosures: Sherwin S. Chan: Consultant, Honoraria: Jazz
Pharmaceuticals, Research Grant: GE Healthcare. All other
authors have disclosed no financial interests, arrangements or
affiliations in the context of this activity.
Purpose or Case Report: Many diseases in pediatrics are
relatively uncommon and imaging of these diseases is difficult
to study due to small patient numbers at a single site. This limits
the ability of single institutions to adequately power a study.
Thus, there is a pressing need for a multi-site structure to
combine data for rare diseases to appropriately power outcome
studies. Our goal is to create an infrastructure to support pooling
of imaging and clinical data across institutions to facilitate
multi-institutional studies.
Methods & Materials: For multi-site studies, a centralized IRB
structure is necessary to efficiently perform the study. The site
establishing the centralized IRB will be considered the
‘primary’ site. The primary site is also responsible for IRB
regulatory, data management, including imaging, and
facilitation of project overall. The centralized IRB will establish
reliance agreements with participating sites, enabling the sites to
utilize the central IRB as the IRB of record. Once IRB approval
is obtained, a centralized REDCap, or data entry system, at the
primary site will grant access to participating institutions for
data entry. Centralized data collection allows all data to be
housed in one location, allowing for quicker analysis. For
studies requiring imaging transfer, a standard operating
procedure (SOP) for image de-identification, naming
convention, and image transfer to centralized PACS system
should be followed.
Results: Our site has established three multi-site clinical
imaging trials to date. First, we have an 11-site imaging
repository for pleuropulmonary blastoma through the Midwest
surgical consortium. All images have been uploaded to our site
and pediatric radiologists at three different institutions are
viewing de-identified images and inputting data in REDCap.
Second, we have a three-site retrospective study evaluating the
use of grayscale and Doppler imaging in veno-occlusive
disease. Each site has access to centralized REDCap and data
entry is performed on local subjects. Third, we have a two-site
retrospective and prospective fetal MRI registry. Data collection
and image upload to centralized PACS is being used to combine
data between institutions.
Conclusions: We have successfully created infrastructure to
support multi-institution clinical imaging trials. We hope that
SPR members can use this resource for future studies on rare
conditions where we can pool data to see how imaging affects
patient outcomes.
Poster #: EDU-043
3D Printed Training Simulation for Assessment of
Pathology in Pediatric Upper GI Fluoroscopy
Neil Lall, [email protected]; Jack McGee, BSE, Korak Sarkar,
MD; Radiology, Ochsner Health System, Orleans, LA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Fluoroscopy of the upper GI tract
(UGI) can be difficult to master given the time-sensitive nature
of the examination, the necessary hand-eye coordination, the
complex button layout and broad featureset of the fluoroscopic
equipment, the desire for minimizing radiation dose, and the
required understanding of normal anatomy. Additionally,
encountering abnormal findings for the first time, particularly
before one is familiar with normal findings, can lead to
confusion and increased difficulty in performing the
examination. The use of 3D printed models of normal anatomy
in pediatric fluoroscopic UGI training simulation has previously
been demonstrated as a viable alternative to learning on live
patients; however, such a technique has not previously been
used with known pathological anatomic configurations.
Methods & Materials: A freely-available computer generated
3D model of the normal anatomy of the esophagus, stomach,
and duodenum was downloaded and modified using Blender™
and Autodesk Fusion 360™. The model was edited to create 4
alternative models corresponding to the 4 classic patterns of
abnormal UGI configuration: Malposition of the duodenal-
jejunal junction (DJJ), corkscrew duodenum, complete duodenal
obstruction, and partial duodenal obstruction with normally
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S165
positioned DJJ. Additionally, known normal variants of
anatomy (such as duodenum inversum) were modeled as
well.Inexpensive reusable simulator models were printed using
a waterproof photo-reactive resin to allow residents to practice
UGI fluoroscopy on both normal and abnormal patients.
Residents were tested on their performance and interpretation of
UGI fluoroscopy on these models to enhance their comfort with
performing the examination and to increase their familiarity
with these important variants/abnormalities.
Results: Though the models were entirely reliant on gravity-
dependent flow of contrast, they behaved similar to real
neonates when filled with contrast and placed in different
positions.
Conclusions: 3D printed models of the UGI tract can serve as
adequate training tools for both general examination
performance as well as education of normal anatomic and
pathological variants.
Poster #: EDU-044
Fabrication and application of realistic three-dimensional
(3D) printed pediatric static and dynamic airway training
models for bronchoscopy and foreign body removal
Pia Maier, [email protected]; Elizabeth Silvestro, MSE,
Samuel B. Goldfarb, MD, Joseph Piccione, MD, Pelton A.
Phinizy, MD, Savvas Andronikou, MBBCh, FCRad, FRCR,
PhD (UCT), PhD (Wits); Children's Hospital of Philadelphia,
Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Successful bronchoscope handling
requires the skill to orient bronchoscope position and direction
in response to the intraluminal view provided by the
bronchoscope camera. Additional challenges for pediatric
physicians are smaller airways and the physiologically higher
breathing frequency and airway collapsibility in babies and
toddlers. We aimed to create a set of anatomically accurate 3D
printed pediatric static and dynamic airway models that can be
further used to teach and train residents/fellows in
bronchoscopy and foreign body removal.
Methods & Materials: Three versions of 3D printed models
were designed: a static tree model, a dynamic tree model, and
translucent airway box model. CT patient data of three different
ages (1, 5, 18) was selected for segmenting in Materialise
Mimics. For the tree methods, the airway was then wrapped
with a 2mm offset and hollowed out to create a lumen-like
model and then was printed in the soft Tango+ material on
Connex 500 or J750 printers. The branches were open for the
static model and closed for the dynamic. The box was created
by subtracting the airway from a box around its extents. This
was then printed in VisoClear on a Project 6000HD printer. A
y-connector and air sucking pump was attached to the dynamic
model to simulate breathing and airway collapsibility.Three
pediatric pulmonology attendings evaluated the models for
physiologic accuracy and usefulness for teaching and training.
Results: All models were evaluated to have an excellent
intraluminal accuracy (branching and angles of bronchi,
appearance of the lumen) and usefulness for teaching and
training. The translucent box was favored for presenting and the
static model to learn basic handling of the bronchoscope in
bronchoscopy and foreign body removal. The dynamic model
provided the most realistic cartilage consistency and endoscopic
simulation of the physiologic breathing patient.Next steps
planned are automatization of breathing simulation with
different age-adjusted breathing frequencies and prospective
enrollment of residents/fellows to formally assess technical skill
development.
Conclusions: By fabricating three different 3D printed airway
models, which enable visualization of bronchoscope handling
and simulation of realistic intraluminal as well as physiological
conditions in different age groups, we created a promising tool
for teaching, training and testing pediatric residents/fellows in
bronchoscopy and foreign body removal.
Poster #: EDU-045: Withdrawn
Poster #: EDU-046
Estimation of Peak Skin Dose with Dose Structure Reports
in a Radiation Data Management System
Xiaowei Zhu, M.S., [email protected]; Jayme Whitaker,
Sphoorti Shellikeri, Master's in Biomedical Engineering, Anne
Marie Cahill; The Children's Hospital of Philadelphia,
Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: It is important for radiologists to
recognize and discuss with patients and families the potential
risks and clinical manifestations of high Peak Skin Dose. In
children undergoing complex Interventional procedures accurate
Peak Skin Dose estimates are complicated and time consuming
despite reference point doses being available. The availability of
the Dose Structure Report (SR) on modern fluoroscopic
equipment allows such estimates to be timely and consistent.
The process of creating a Peak Skin Dose estimate using a
validated radiation data management system (RDMS), capable
of collecting detailed acquisition data and modeling will be
discussed.
Methods & Materials: Interventional fluoroscopic equipment
is configured to transfer the SR to the hospital PACS system
(PACS). PACS sends SR to a RDMS, which interprets SR
reports and provides details of each study acquisition including:
dose area product, reference point dose, beam on time, pulse
rate, pulse width and height, table positions, collimation,
preliminary and secondary angulations, distances of source to
table and receptor. Acquisition protocols, timeline, and
angulation maps are generated for each study. A Peak Skin
Dose estimate for each study is performed using the detailed
acquisition data, with manual adjustments made for table offsets
in lateral and longitudinal directions, patient orientation and
skin model (i.e. patient size). The skin dose map can be
captured and used for initial and follow-up discussions with
patients and families.
Results: For all studies, a default Peak Skin Dose estimate and a
color skin dose map are automatically generated. With a pre-set
institutional threshold (1 Gy) for Peak Skin Dose evaluation,
RSMS automatically alerts the lead staff members of IR and
physicist if the threshold level is exceeded upon completion of
the study. The Peak Skin Dose estimate is then re-calculated
with minor adjustments as described above. The skin dose map
can be captured and used for initial and follow-up evaluations
with patients and families.Two cases are selected for
demonstration: 1) >1Gy Reference Point Dose, < 2Gy Peak
Skin Dose; 2) >1Gy Reference Point Dose, > 2Gy Peak Skin
Dose.
Conclusions: Using SR in RDMS for estimates of Peak Skin
Dose can provide clinicians with timely Peak Skin Dose data to
inform clinical patient follow up. This technology can also be a
useful tool in the investigation of a potential sentinel event and
in planning future similar interventions
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S166
Poster #: EDU-047
Instituting an Interventional MRI program at a pediatric
institution
Sphoorti Shellikeri, Master's in Biomedical Engineering1,
[email protected]; Randolph M. Setser, PhD2,
Michael Acord, MD1, Abhay Srinivasan, MD1, Seth Vatsky1,
Fernando Escobar, MD1, Jayme Whitaker1, Anne Marie
Cahill1; 1Radiology, Children’s Hospital of Philadelphia,
Philadelphia, PA, 2Siemens Healthineers, Hoffman Estates, IL
Disclosures: Randolph M. Setser, PhD: Salary: Siemens
Healthineers. All other authors have disclosed no financial
interests, arrangements or affiliations in the context of this
activity.
Purpose or Case Report: Percutaneous interventions are
increasingly being performed under MR-guidance due to the
absence of ionizing radiation, the ability to visualize target
lesion and the capability to monitor real-time treatment effect.
Here we outline our experience with developing an
interventional MRI (iMRI) service at a pediatric institution.
Methods & Materials: Subjects of discussion include:
education, interventional use of diagnostic MR suites, coil
types, MR-compatible supplies, billing and scheduling codes,
MR safety training, creation and optimization of procedure
specific MR protocols, building/simulation of procedural
workflow, initial procedure selection, and role assignments for
MR and IR personnel.
Results: Site visits to a well established interventional MR
program for procedural and workflow observation informs the
initial education and training. The choice of a 1.5T/3T scanner
is institution specific with consideration for more needle artifact
with 3T field strength. Appropriate fast imaging sequence
protocols and installation of a slave monitor for in-suite
visualization of procedures is required. Sequences should be
tailored so that the visibility of saline, gadolinium and/or
needles is optimized and artifacts are minimized. Protocols can
be tested using basic gel or other phantoms.MRI coils are
tailored to the intervention, including surface, flex and shoulder
coils. MR-compatible interventional equipment is required but
limited in availability. Coil choice to enable needle placement
and appropriate protection of coil during sterile procedures
requires planning and ideally phantom testing. Billing and
scheduling codes can be created with the expertise of IR
specific coding personnel. Most importantly the entire
interventional team needs to complete MRI safety
training.Roles assignments need to be clearly defined. In our
institution this is a follows; IR technologist manages the MR-
compatible supplies stocked on an MR-compatible rolling table,
and assist the IR physician during the intervention; the IR nurse
monitors the patient; the MR technologist controls the MR host;
and the IR physician performs the intervention. It is ideal to
start the program with a relatively non-complex non sedated
intervention, as in our institution MRI-guided shoulder
arthrography.
Conclusions: Conventional MRI suites can be adapted for
interventional procedures. Collaborating with experienced
institutions and thoughtful proactive planning are keys to a safe
and successful iMRI program.
Poster #: EDU-048
An Overview of Techniques for Intrathecal Administration
of Nusinersen in Children with Spinal Muscular Atrophy
Carlos B. Ortiz1, [email protected]; Alex Chau, MD2,
Sudhen Desai2, Kamlesh Kukreja, MD2; 1Department of
Radiology, Baylor College of Medicine, Houston, TX, 2Texas
Children's Hospital, Houston, TX
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: 1) Reviewing the pathology and
outcomes of children with spinal muscular atrophy (SMA)2)
Learning the procedures available for intrathecal access3)
Understanding the indications for choosing more advanced
techniques to deliver nusinersenSpinal muscular atrophy is an
autosomal recessive disease affecting motor neurons and is the
most common genetic cause of death in infants. Nuinersen
(Spinraza) was recently approved by FDA for intrathecal
administration in SMA patients. Commonly administered by
lumbar puncture in the clinic or with imaging guidance, this is
the initial method of administering nusinersen. Deformities and
spinal instrumentation from orthopedic surgeries are common in
SMA patients, preventing traditional intrathecal access by
lumbar puncture for nusinersen delivery. Transforaminal lumbar
sac access, ultrasound or fluoroscopy guided cervical spine
access, or subcutaneous catheter placement can be the
alternative approaches with failed/difficult lumbar access. Given
the potential benefit of nusinersen, understanding all methods to
obtain intrathecal access is essential for a pediatric
interventional radiology (IR) practice.
Methods & Materials: We intend to review the technique,
indications, complications, tips and tricks for each of these
techniques and their relevance to an IR practice.1) Ultrasound
guided lumbar puncture2) Fluoroscopy guided lumbar
puncture3) Ultrasound guided cervical puncture4) Fluoroscopy
guided cervical puncture (C1-C2)5) Transforaminal delivery
using cone-beam computed tomography6) Transosseous access
via drill7) Subcutaneous Intrathecal Catheter System
Conclusions: Nusinersen administration for SMA is providing a
novel treatment for a previously untreatable condition and the
number of patients requiring these procedures is expected to
increase. Pediatric interventional radiologists can provide the
safest approach for delivering nusinersen by being aware of the
options.
Poster #: EDU-049
Eliminating Radiation and Decreasing Sedation Time For
Pediatric Peripherally Inserted Central Catheter (PICC)
Placement: A Technical Review
Malay Bhatt, MD, [email protected]; Alyssa
Kirsch, Terrence Metz, MD; Diagnostic Radiology, Beaumont
Hospital-Royal Oak, Royal Oak, MI
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To familiarize the audience with our
institution’s technique utilizing ultrasound (US) and
electrocardiogram (ECG) for anatomic localization and
technical guidance for PICC placement in a pediatric intensive
care unit (PICU) procedure suite utilizing intravenous (IV)
sedation without general anesthesia to eliminate patient and
operator radiation exposure and decrease sedation specifically in
a pediatric population.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S167
Methods & Materials: A majority of our institutions pediatric
(newborn to 18 years) PICC placements are performed in our
PICU procedure suite under IV sedation only, administered by
qualified attending pediatric intensivists. The procedure is
performed with US and ECG guidance which is described.
Results: Initial procedural suite preparation is described
including patient and operator positioning. Patient preparation
and localizing ECG device placement as well as ECG
interpretation for final PICC placement is explained. Finally,
troubleshooting techniques and complication management is
reviewed.
Conclusions: Although ECG-guided PICC placement is
currently used in the adult population, it is a newer and unique
technique used for the pediatric population at our institution
allowing decreased sedation times and anesthetic use as well as
eliminating patient and operator radiation exposure. The
technique is described to the audience.
Poster #: EDU-050
Imaging Essentials of Congenital Foot Deformities
Elizabeth P. Wellings, MD1, Monica Epelman, MD2, Tushar
Chandra, MD2, Jason Malone, DO3, John F. Lovejoy,
MD3, Arthur B. Meyers, MD2, [email protected];
1Orthopedic Surgery, Mayo Clinic, Rochester, MN, 2Department of Radiology, Nemours Children's Hospital and
Health System, Orlando, FL, 3Department of Orthopedics,
Nemours Children’s Hospital and Health System, Orlando, FL
Disclosures: Arthur B. Meyers, MD: Royalty: Author/Editor
for Amirsys, Elsevier. All other authors have disclosed no
financial interests, arrangements or affiliations in the context of
this activity.
Purpose or Case Report: This education exhibit will provide a
general review of radiographic techniques of the foot followed
by a section identifying clinical and radiographic findings for
specific foot deformities. Learning objectives for this exhibit
include: (a) recognize the imaging needed for specific foot
deformities, (b) measure critical angles from different
radiographic views and interpret their meanings, (c) recognize
radiographic identifying features for specific foot deformities,
(d) identify what views are necessary when trying to
differentiate between similar deformities, and (e) interpret post-
operative/post-procedural imaging and recognize possible
complications.
Poster #: EDU-051
Algorithm-based approach to the evaluation and diagnosis
of congenital skeletal dysplasia
Marcus I. Hook, MD, [email protected]; Timothy
Higgins, MD, Andrea Hildebrand, MD, Betsy Sussman, MD,
Leah Burke, MD; Radiology, University of Vermont Medical
Center , Burlington, VT
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Objectives:1. Present the use of a
published algorithm for the evaluation and diagnosis of the
pediatric patient with congenital skeletal dysplasia and
abnormal skeletal survey.2. Review usefulness of accurate,
narrowed differential diagnosis or suspected single diagnosis in
terms of confirmatory testing, treatment implications, and
genetic counseling.3. Demonstrate the utility of the algorithm
when applied to recent, rare cases of congenital skeletal
dysplasia at our institution, a tertiary trauma center and
children’s hospital in the Northeastern United
States.Content:We present a refined, algorithm-based approach
to the evaluation and diagnosis of the pediatric patient with
congenital skeletal dysplasia and abnormal skeletal survey. The
algorithm optimizes evaluation of the skeletal survey in cases of
congenital skeletal dysplasia, aiding in timely, accurate
diagnosis. The utility of the refined algorithm is demonstrated
as it was applied to recent, confirmed cases of rare skeletal
dysplasias at our institution, including metatropic dysplasia and
cleidocranial dysplasia.Teaching Message:Evaluation of the
pediatric patient with congenital skeletal dysplasia and
abnormal skeletal survey can be challenging, even for the
subspecialty-trained radiologist. By assessing the presence or
absence of discriminating imaging features and findings on
skeletal survey, the interpreting radiologist can significantly
shorten the differential diagnosis or in many cases suggest a
single, most-likely primary diagnosis. Narrowing the
differential diagnosis is helpful in guiding confirmatory
molecular or genetic testing. Timely, accurate diagnosis may
have significant treatment and prognostic implications for
patients and their families.
Poster #: EDU-052
When soft tissues turn hard - ossifying soft tissue lesions.
Anna Smyth, [email protected]; Rosemond N.
Aboagye, BSc Med Sci, MB ChB, Anna Lee, MD, Heather
Bray, MD; radiology, BC Children’s Hospital, Vancouver,
British Columbia, Canada
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: The purpose of this educational
exhibit is to illustrate the radiological appearance of various
ossified soft tissue lesions. The differential diagnosis is wide,
with entities ranging from benign to malignant. Using
instructive and interesting cases encountered at our department,
this presentation will outline an approach to forming a
differential diagnosis. Various teaching points will be
highlighted. Pathological correlation will be included where
available.The cases to be presented include:Myositis
ossificansFibrodysplasia ossificans progressivaTenosynovial
osteochondromatosisDysplasia Epiphysealis
HemimelicaPseudohypoparathyroidism - Albright’s hereditary
osteodystrophyPhlebolith in a vascular
malformationPilomatrixomaHeterotopic ossificationSynovial
SarcomaThis presentation will highlight the distinguishing
imaging characteristics of each entity and help narrow the
differential diagnosis for a radiologist when faced with a
pediatric ossified soft tissue lesion.
Poster #: EDU-053
Don't Be Nervous About the Nerves!: A Sonographic
Review of the Normal Appearance of Peripheral Nerves and
the Spectrum of Disease Pathology That Can Affect Them
Jillian R. Krauss, MD, [email protected]; Jonathan
Samet, MD; Northwestern Feinberg School of Medicine Ann &
Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: At our institution and in general
practice, we have observed that ultrasound is an underutilized
modality in the field of pediatric musculoskeletal imaging,
particularly when compared to its body imaging counterparts
and the adult population. Within the spectrum of
musculoskeletal radiology, ultrasound can be an especially
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S168
helpful tool in evaluating the peripheral nervous system (PNS),
which can often be challenging to assess on other imaging
modalities. For instance, ultrasound offers the ability to
carefully trace small nerves and easily allows for comparison to
the other, often unaffected or normal extremity, as well as
dynamic imaging. This advantage is often not possible on
magnetic resonance imaging (MRI), which is currently the
primary modality being utilized to assess for nerve pathology.
In small children, nerves are often difficult to visualize on MRI,
which can be limited by artifact and motion and may require
sedation. Due to its superior axial resolution, ultrasound can
better visualize the intra-neural architecture, sometimes better
than MRI, especially in the case of small nerves. Also, as was
demonstrated by one of the cases at our institution, ultrasound
was superior in evaluation when there was adjacent surgical
hardware which resulted in artifact on MRI. Additionally, we as
radiologists, can aid our peripheral nerve surgeon colleagues
intra-operatively with ultrasound.Some of the hesitance in using
the modality may be a reflection of a lack of familiarity on the
part of both radiologists and technologists with respect on how
to image the PNS and uncertainty about the normal and
abnormal appearance of these structures. The objective of this
educational exhibit is to provide the knowledge necessary to
successfully acquire and interpret ultrasound images of the PNS.
The topics addressed in the review will include an introduction
on how to appropriately obtain images of the major peripheral
nerves, how to distinguish between the normal and abnormal
appearance of nerves on ultrasound, and the spectrum of
pathology affecting the peripheral nervous system. The exhibit
will feature a variety of cases from our institution, including
examples of neuropathy, post-traumatic focal neuroma, nerve
laceration resulting in transection, ulnar nerve
subluxation/dislocation, and nerve sheath tumors, among others,
with some intraoperative and pathologic correlation.
Poster #: EDU-054
Clinical update on high resolution magnetic resonance
imaging of small joints in children and adolescents using 3D
proton density fat suppressed turbo spin echo imaging
accelerated with compressed sensing
Eric Padua, MD1, [email protected]; Bamidele
Kammen1, S Pinar Karakas, MD1, Dave Hitt2, Chau Tai, MD1,
Nirav Pandya1, Quin Lu2, Taylor Chung, MD1;1Diagnostic
Imaging, UCSF Benioff Children's Hospital Oakland, Oakland,
CA, 2Philips Healthcare North America, Gainesville, FL
Disclosures: Dave Hitt: Salary: Philips HealthTech; Nirav
Pandya, MD: Consultant/Honoraria: Orthopediatrics; Quin Lu,
PhD: Salary: Philips. All other authors have disclosed no
financial interests, arrangements or affiliations in the context of
this activity.
Purpose or Case Report: Current musculoskeletal MR
imagiing utilizes multiple imaging planes and multiple
weightings of two-dimensional turbo spin echo (2D TSE) to
precisely delineate and characterize intra-articular
abnormalities. Three-dimensional (3D) TSE sequences are
currently available on most MRI vendor platforms. High
resolution isotropic 3D imaging of the small joints reduces
partial volume artifacts and allows for the reconstruction in any
orientation, thus eliminating the need to acquire additional scans
of different orientations with identical tissue contrast. However,
the typical trade off of achieving very high resolution (under
0.5mm isotropic) is long acquisition time. Scan time reduction
can be achieved with parallel imaging at the expense of
reducing the signal-to-noise ratio (SNR) and with increasing the
echo train length at the expense of image blurring. The addition
of compressed sensing (CS), a recently commercially available
acceleration technique, allows for decrease in acquisition time
without the significant loss of SNR experienced with identical
acceleration factors achieved with parallel imaging alone. CS
exploits (1) image data sparsity via application of a sparsity
transform of the image data; (2) pseudo-random-type of k-space
sampling; (3) non-linear iterative reconstruction. We utilized CS
to decrease scan time (range 4:55 to 5:35 minutes) of 3D PD FS
TSE sequences to obtain high resolution (voxel size 0.45 x 0.45
x 0.45) imaging of the fingers, toes, wrist and feet. In this
educational exhibit, we will review the normal anatomy and
pathology of small joints
Poster #: EDU-055
Behind closed doors. Detecting Posterior Acetabular
Fractures in Adolescence.
Kevin P. Boyd, DO, [email protected]; Pooja Thakrar,
MD; Pediatric Imaging , Medical College of Wisconsin,
Milwaukee, WI
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: The purpose of the exhibit is: 1.
Illustrate the presence of multiple and accessory ossification
centers about the hip that can make it challenging to diagnosis
fractures on radiographs in adolescence. 2. Demonstrate that
posterior acetabular fractures are typically hidden behind the
femoral head on radiographs. 3. Review variant os acetabuli that
are commonly encountered in patients with hip pain and
demonstrate that the orientation of the fragments compared with
posterior acetabular fractures can help to make a distinction. 4.
Highlight that a complete pelvis radiograph (AP or AP/Frog leg
lateral) in trauma patients or hip pain NOS can aid in the
detection of fractures and assess for asymmetry of normal
variants.
Poster #: EDU-056
Beyond a Lesionable Doubt: An Algorithmic Approach to
Pediatric Soft Tissue Lesions on Ultrasound
Sarah Eliades, MD, [email protected]; Christy B.
Pomeranz, MD, Michael Baad, MD, Michelle Roytman,
MD, Arzu Kovanlikaya, MD; Radiology, NewYork
Presbyterian-Weill Cornell Medical Center, New York, NY
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Ultrasound is typically the first-line
imaging modality for the evaluation of superficial soft tissue
masses in the pediatric population. While certain superficial soft
tissue masses have a classic appearance on ultrasound, others
may have a nonspecific appearance and may vary in their
sonographic characteristics. This can make a definitive
diagnosis and follow-up recommendations difficult, especially
for trainees.We aim to provide a basic overview of some of the
common and less common superficial soft tissue masses that
may be encountered in pediatric imaging, and introduce a novel,
structured algorithmic approach for evaluating these lesions on
ultrasound. The algorithm will assist the radiologist in reaching
a definitive diagnosis or narrowing the differential such that a
helpful recommendation for further workup can be made. For
example, the algorithm will include internal vascularity, border
distinctness, cystic or solid components, presence or absence of
calcifications, and location in the body and within the
superficial soft tissue layers. Pictorial examples of each
sonographic feature in the algorithm will provide further
assistance.Pathologies will include but not be limited to:
pilomatricoma, glanuloma annulare, epidermal inclusion cyst,
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S169
ganglion cyst, abscess/infection, lipoma, hematoma, lymph
nodes, vascular anomalies, and soft tissue sarcomas. When a
definitive diagnosis is not achievable, this algorithm will help
the radiologist determine the likelihood of benignity, a short
differential diagnosis, and a recommendation for any further
imaging workup.
Poster #: EDU-057
Imaging of Gaucher Disease in Children: Advances in
Comprehensive Assessment of Disease Involvement
Andrew J. Degnan, MD, MPhil, [email protected];
Suraj Serai, Victor Ho-Fung, MD, Christian A. Barrera,
M.D., Dah-Jyuu Wang, Rebecca Ahrens-Nicklas, Can
Ficicioglu; Radiology, Children's Hospital of Philadelphia,
Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Gaucher disease is an inherited
metabolic disorder due deficiency of the lysosomal enzyme β-
glucocerebrosidase that results in the accumulation of abnormal
macrophages (“Gaucher cells”) within multiple organs, most
conspicuously affecting the liver, spleen and bone marrow. As
the diagnosis is increasingly made during childhood and young
adulthood, pediatric radiologists should be familiar with
imaging features of Gaucher disease and its
complications.Visceromegaly consisting of hepatosplenomegaly
is a hallmark of Gaucher disease and uniformly present in
cohorts of pediatric patients. In addition, bone marrow
involvement with ‘Erlenmeyer flasks’ have been long
recognized as part of this disease, although the classic
radiographic finding is not present until adulthood. Marrow
involvement confers significant morbidity for these patients
with pain, bone infarcts and pathologic fracture.Traditionally,
imaging of disease severity has been based on hepatic and
splenic visceral organ enlargement and/or qualitative
assessment of bone marrow involvement. However, advances in
the understanding of Gaucher disease and observations of
elevated ferritin levels and increased risk of hepatic fibrosis
emphasize the importance of more comprehensive assessment
of liver involvement beyond simple enlargement. Moreover,
quantitative MRI assessment of bone fat-fractions also may
have a role in assessing marrow involvement. These methods of
disease assessment are important in addressing management
decisions regarding enzyme replacement and substrate reduction
therapy.
Conclusions: This presentation summarizes the imaging
evaluation of Gaucher disease as it pertains to pediatric patients.
We review multimodal conventional imaging manifestations of
Gaucher disease from radiographic manifestations to MRI
appearances. Semi-quantitative marrow scoring methods are
discussed. This exhibit also discusses newer quantitative
approaches to assessment of liver and bone marrow
involvement with an emphasis on future applications of
advanced methods including spectroscopy, elastography, fat-
fraction and iron quantification in guiding therapy decisions and
monitoring treatment response.
Poster #: EDU-058
Skeletal Ciliopathy: A Primer on a Major Bone Dysplasia
Family
Atsuhiko Handa1, [email protected];
Gen Nishimura, Dr.2; 1Radiology, University of Iowa, Iowa
City, IA, 2Saitama Medical University, Saitama, Japan
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: A term “ciliopathy” represents a
diverse group of genetic disorders caused by mutations in genes
coding for components of the primary cilia. Primary cilia have a
pivotal biological role in the cell surface of nearly every organ
system of the body. "Skeletal ciliopathy" is a subset of
ciliopathy mainly affecting the skeleton and shares common
radiological findings such as short ribs, short limbs, and short
digits with or without polydactyly. Pattern recognition approach
is thus useful to diagnose skeletal ciliopathy. Skeletal ciliopathy
includes (1) Jeune asphyxiating thoracic dysplasia, (2) Ellis-van
Creveld syndrome (chondroectodermal dysplasia), (3)
Sensenbrenner syndrome (cranioectodermal dysplasia), and (4)
Short rib-polydactyly syndromes. Clinically, affected patients
commonly present with thoracic hypoplasia with respiratory
failure and disproportional stature with a normal trunk and short
limbs most severe in the distal segments. Brachydactyly is
conspicuous. Patients may have extra-skeletal anomalies such as
retinopathy, cardiac anomalies, cerebellar malformations, and
hepatorenal failures.Radiological diagnosis of bone dysplasia
might be regarded as something complex. We aim to highlight a
pattern recognition approach to diagnose skeletal ciliopathies,
one of the major bone dysplasias, by providing many cases. We
will also review a general concept of "bone dysplasia family"
which refers to a grouping of radiologically similar skeletal
disorders into a “family.” This concept has been widely
accepted now after we found that phenotypic similarities usually
indicate the same/similar pathogenetic mechanisms, and it
supports the use of a pattern recognition approach. Imaging
diagnosis can guide genetic testing, interpretation, and possibly
identify new genes or mutations.
Poster #: EDU-059
In-phase and opposed-phase evaluation of bone marrow
lesions in the pediatric population.
Mariangeles Medina Perez, MD, [email protected];
Saurabh Gupta, MBBS, Ninad Salastekar, MBBS, MPH, Zain
Badar, MD, Anand Majmudar, MD; Radiology, SUNY Upstate
Medical University, Syracuse, NY
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Bone marrow is composed of fat and
cellular elements supported by the trabecular bone. Pathological
lesions of the bone marrow usually replace its normal
constituent to a variable degree. Differentiation among
traumatic, neoplastic, and inflammatory processes of the bone
marrow is often not possible with MRI, which commonly
requires the patient to undergo additional invasive diagnostic
procedures to obtain an accurate diagnosis.In-phase and
opposed-phase imaging has been used extensively in imaging of
the liver and adrenal glands. However, recently it has been
introduced into the evaluation of the bone marrow. The
technique takes advantage of different excitation frequencies of
water and fat protons due to differences in their molecular
environments. The main concept is that the presence of normal
bone marrow would result in suppression of signal intensity on
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S170
the opposed-phase images. In the presence of infiltration lesions
of the bone marrow, normal fat-containing marrow will be
replaced with neoplastic cells and result in lack of suppression
on the opposed-phase images.The main teaching purpose of this
exhibit will be to demonstrate, by a pictorial case-based review,
the appearance of multiple cases of biopsy-proven infiltrating
lesions of the bone marrow, and emphasize how they can be
differentiated from other traumatic or inflammatory processes.
Poster #: EDU-060
Congenital fibular deficiency. Diagnosis, Image-based
Classification, and Follow-up
Eman E. Marie, M.D.- M.Sc., [email protected];
Manuela Perez, MD, Michael R. Aquino, MD, Jennifer
Stimec; The Hospital For Sick Children, Toronto, Ontario,
Canada
Disclosures: Michael R. Aquino, MD: Royalty Income:
Elsevier Co-author. All other authors have disclosed no
financial interests, arrangements or affiliations in the context of
this activity.
Purpose or Case Report: Although rare, fibular hemimelia or
congenital fibular deficiency (CFD), is the most common
congenital long bone deficiency, with an approximate incidence
of 7.4- 20 per 1 million live births. The clinical presentation of
CFD represents a broad spectrum of manifestations, ranging
from mild fibular deficiency with limb length discrepancy to a
significantly short limb with multiple associated foot, ankle and
knee deformities.Traditional FH classification such as
Achterman and Kalamchi described the amount of fibular
deficiency, which is today known to be unrelated to length
discrepancy and foot deformity. Current classifications are
based on the associated deformities of the ankle and subtalar
joint, as the foot deformity is the main prognostic
factor.Treatment should be tailored for each patient to maximize
the lower limb function - this involves predicting the limb
length discrepancy and then coming up with a surgical plan to
correct these in the fewest number of surgeries spread out as
much as possible throughout the child’s growing years, so that
by skeletal maturity the child has achieved equal leg length, a
functional plantigrade foot, excellent alignment of the hip, knee
and ankle and, as needed, a stable knee joint.Multimodal
imaging provides detailed evaluation of the osteochondral and
extraosseous malformations. In-utero identification can be
accomplished with prenatal ultrasonography. After birth,
radiographs often show striking bony anomalies. Detailed
information regarding associated crucial cartilaginous, articular,
soft tissue, and vascular abnormalities required for preoperative
planning necessitates the use of magnetic resonance (MR)
imaging.The purpose of this poster is to: 1) review the various
types of osteochondral and extra-osseous abnormalities of CFD
as depicted by different imaging modalities, 2) describe the
limitations of each of these modalities, 3) outline the image-
based classification of CFD, 4) describe the options for
treatment, and 5) discuss the post-operative imaging evaluation
of CFD.
Poster #: EDU-061
Preliminary Definitions for Sacroiliac Joint Pathologies in
the OMERACT Juvenile Idiopathic Arthritis MRI Score
(OMERACT JAMRIS-SIJ)
Tarimobo M. Otobo, MD1, [email protected]; Philip
G. Conaghan2, Walter P. Maksymowych3, Desiree van der
Heijde4, Pamela F. Weiss5, Iwona Sudol-Szopinska6, Nele
Herregods7, Jacob L. Jaremko8, Arthur B. Meyers, MD9, Dax
Rumsy10, Emilio C. Inarejos11, Eva Kirkhus12, Jennifer
Stimec1, Jyoti Panwar, MD, FRCR1, Kevin Thorpe13, Lennart
Jans7, Marion A. van Rossum14, Mirkamal Tolend1, Manuela
Perez, MD1, Nikolay Tzaribachev15, Pulukool
Sandhya16, Shirley Tse1, Appenzeller Simone18, Vimarsha G.
Swami19, Zahi Touma17, Robert Lambert8, Andrea Doria,
MD1; 1Diagnostic Imaging , Hospital for Sick Children ,
Toronto, Ontario, Canada, 2Leeds Institute of Rheumatic and
Musculoskeletal Medicine, University of Leeds & NIHR Leeds
Biomedical Research Centre, Leeds Teaching Hospitals NHS
Trust, Leeds, United Kingdom, 3Department of Rheumatology,
University of Alberta, 562 Heritage Medical Research Building,
Edmonton, Alberta, Canada, 4Department of Rheumatology,
Leiden University Medical Center, Leiden, Netherlands,
5University of Pennsylvania Perelman School of Medicine,
Division of Rheumatology, Children’s Hospital of Philadelphia,
Philadelphia, PA, 6Department of Radiology, National Institute
of Geriatrics, Rheumatology and Rehabilitation, Warsaw,
Poland, 7Department of Radiology and Medical Imaging, Ghent
University Hospital, De Pintelaan 185, Ghent, Belgium, 8Department of Radiology and Diagnostic Imaging, University
of Alberta, Edmonton, Alberta, Canada, 9Nemours Children's
Hospital, Orlando, FL, 10Division of Pediatric Rheumatology,
Department of Pediatrics, University of Alberta, Edmonton,
Alberta, Canada, 11Department of Radiology; Hospital Sant
Joan de Deu, Passeige de Sant Joan deDeu, Esplugues de
Llobregat, Barcelona, Spain, 12Department of Radiology,
Rikshospitalet, Oslo University Hospital, Oslo, Norway, 13Dalla
Lana School of Public Health, University of Toronto, 155
College Street, Toronto, Toronto, Ontario, Canada, 14Reade |
Emma Children’s Hospital / Academic Medical Center,
Amsterdam, Netherlands, 15Pediatric Rheumatology Research
Institute, PRI Achtern Dieck 9, Bad Bramstedt, Germany,
16Department of Clinical Immunology and Rheumatology,
Christian Medical College, Vellore, India, 17Department of
Rheumatology, Center for Prognosis Studies in Rheumatologic
Diseases, Toronto Western Hospital, Toronto, Ontario,
Canada, 18Department of Medical Imaging, University of
Toronto, Toronto, Ontario, Canada
Disclosures: Arthur B. Meyers, MD: Royalty: Author/Editor
for Amirsys, Elsevier. All other authors have disclosed no
financial interests, arrangements or affiliations in the context of
this activity.
Purpose or Case Report: Clinical assessment of the Sacroiliac
Joint (SIJ) is limited due to the location and anatomy of the
joint. Magnetic Resonance Imaging is a sensitive, non- invasive
tool in detecting early SIJ inflammatory changes and structural
damage in Juvenile Idiopathic Arthritis (JIA). The
quantification of interval change of pediatric SIJs using MRI
based scoring methods will serve as an important objective
outcome measure for the assessment of disease severity and
treatment effectiveness in JIA.
Methods & Materials: The OMERACT consensus-driven
methodology consisting of iterative surveys and focus group
meetings within an international group of pediatric
rheumatologists and radiologist was utilized to decide the
measurement construct, items, and definitions. Consensus was
deemed to have been achieved if greater than 70% agreement
was reached among voting attendees at the session in the
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S171
absence of greater than 15% present or more in strong
disagreement.
Results: Twenty-eight international multidisciplinary experts
from North America, Europe, South Asia and South America
participated in the study. Two domains, inflammation and
structural, were identified. Definitions for bone marrow edema,
joint space inflammation, capsulitis, and enthesitis were derived
for joint inflammation; sclerosis, erosion, fatty lesion and
ankylosis were defined for assessing structural joint changes.
Conclusions: Preliminary consensus-driven definitions for
inflammation and structural elements have been drafted,
underpinning the ongoing development of the Juvenile arthritis
MRI scoring system for SIJ (JAMRIS-SIJ).
Poster #: EDU-062
Proximal humeral epiphyseal fracture-separation in infants
Edward P. Fenlon, MD1,[email protected]
Andrew J. Degnan, MD, MPhil2, Alexis B. Maddocks, MD1,
Susie Chen, MD1, Diego Jaramillo, MD MPH1; 1Radiology,
Columbia University Medical Center, New York, NY, 2Children's Hospital of Philadelphia, Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Proximal humeral epiphyseal
fracture-separation is a rare fracture pattern in infants often
associated with birth-related or non-accidental trauma,
representing a Salter-Harris type I or type II fracture. Lack of a
proximal humeral epiphyseal ossification center in most
newborns or only subtle displacement of a small epiphyseal
ossification center in older infants, makes this injury difficult to
diagnose on plain radiographs, potentially leading to delayed
diagnosis or misdiagnosis. Ultrasound and MRI are therefore
useful imaging modalities in indeterminate cases.Clinical
findings of infant proximal humeral epiphyseal fracture-
separation such as shoulder swelling, tenderness, and decreased
active motion, overlap with more common entities including
clavicular fracture, brachial plexus injury and osteomyelitis.
Radiographs are often the first diagnostic study ordered to
evaluate these symptoms but are insensitive due to minimal
ossification of the proximal humeral epiphysis. Radiographs
may be normal or show subtle displacement of the epiphyseal
ossification center, apparent joint space widening, small
metaphyseal fracture fragments or displacement of the proximal
humeral metaphysis in relation to the scapula. These findings
can be misdiagnosed as shoulder dislocation or
pseudosubluxation due to a joint effusion. Careful review of the
medical record may elucidate a history of difficult delivery with
shoulder dystocia or suspected shoulder trauma.Ultrasound and
MRI are useful in indeterminate cases due to their ability to
resolve the cartilaginous physis and proximal humeral
epiphysis, and to resolve their relationship to the humeral shaft
and cartilaginous labrum. Ultrasound has higher anatomic
resolution and offers the flexibility to quickly image the
asymptomatic contralateral shoulder and image in planes that
best show the relationship between the non-ossified epiphysis
and the humeral shaft. Doppler ultrasound demonstrates
epiphyseal perfusion without the need for contrast
administration, and serial ultrasound imaging can be used to
evaluate healing and remodeling. MRI is more useful in
evaluating cases where osteomyelitis and/or septic arthritis are
being considered, or in cases of an inconclusive history
suspicious for non-accidental trauma to evaluate for additional
osseous and soft tissue injuries.Several examples of typical
proximal humeral epiphyseal fracture-separations in infants will
be presented and the relevant imaging findings discussed.
Poster #: EDU-063
AVID: A Cause of Mistaken Diagnoses
Megan Albertson1, [email protected]; Andria M.
Powers, MD2, Angela Beavers, MD2; 1University of Nebraska
Medical Center, Omaha, NE, 2Children's Hospital & Medical
Center, Omaha, NE
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Background:AVID is an acronym
describing a triad of findings including 1) asymmetric
ventriculomegaly, 2) interhemispheric cyst, and 3) dysgenesis of
the corpus callosum. This entity accounts for one of the
presentations of callosal dysgenesis along a wide spectrum.
Because midline anomalies occur with many processes,
including holoprosencephaly and aqueductal stenosis, it may
appear to have overlapping features on initial glance. However,
by focusing attention on the secondary findings, a specific
diagnosis may be determined.Objectives:By the end of this
presentation the learner will: 1) Become familiar with the
imaging characteristics of AVID. 2) Describe the differential
diagnosis of AVID and the important distinguishing features. 3)
Understand the clinical implications of interhemispheric cysts
and similar diagnoses.Cases/Differential Diagnosis:Through
several case examples of mistaken diagnoses, we will describe
key findings to differentiate brain disorders with midline
anomalies including AVID, holoprosencephaly, and aqueductal
stenosis. Holoprosencephaly creates a monoventricle, but may
also be associated with a dorsal midline cyst which can be
confused for an interhemispheric cyst. Features that differentiate
holoprosencephaly from AVID are the presence of fused
cerebral hemispheres, thalamic fusion, and a true
monoventricle. Aqueductal stenosis may also show severe
hydrocephalus, but lacks the cystic component which is seen
with the other mentioned entities. Aqueduct stenosis usually
causes symmetric ventriculomegaly of the lateral and 3rd
ventricles as well as upward displacement of anterior cerebral
arteries and inferior displacement of internal cerebral veins. The
hydrocephalus from all of these entities may be treated with
ventricular shunt placement, but AVID is an important
diagnosis to consider because the wall of the interhemispheric
cyst could be imperceptible by imaging and may not improve if
the tip of the drainage catheter is not within the cyst.
Conclusion: When evaluating cases of true ventriculomegaly it
is important to consider a differential including AVID,
holoprosencephaly, aqueductal stenosis, among other less
common congenital syndromes. Careful attention to additional
imaging findings is necessary to distinguish the correct
diagnosis from look-alikes. Making an accurate diagnosis is
important as there are differences in medical decision making,
treatment outcomes, and long-term prognosis.
Poster #: EDU-064
Acquired non-traumatic temporal bone lesions in children:
A Pictorial Review.
Ashok Mithra Karuppiah Viswanathan,
[email protected]; Nagwa Wilson; CHEO, University
of Ottawa, Ottawa, Ontario, Canada
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: A number of acquired non-traumatic
diseases of myriad aetiologies involve the temporal bone in
children. While some of these are also noted in adults, many
diseases are specific to the pediatric age group. These can be
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S172
grouped into infectious/inflammatory, neoplastic, vascular and
other miscellaneous disorders.Anatomy of the temporal bone is
complex. It forms the lateral aspect of skull base and comprises
of five osseous parts viz. squamous, mastoid, petrous, tympanic
and styloid segments. Specific disease processes afflict each
part of the temporal bone, largely dictated by its anatomy and
constituent structures. Hence a structured approach to image
interpretation and reporting is especially useful in this region to
localise the lesion and subsequently generate differential
diagnoses.Traditionally CT has been the imaging modality of
choice in assessing temporal bone lesions. However, currently,
CT and MRI are deemed complimentary. CT provides exquisite
details of anatomy, characterises osseous lesions, determines
bony involvement/destruction and extension while MRI is
highly useful in assessing intrinsic lesion characteristics due to
its superior contrast resolution. In certain aetiologies such as
cholesteatoma MRI is diagnostic.This poster aims to review the
anatomy of temporal bone and various common, uncommon
acquired non traumatic temporal bone lesions in children.The
lesions that will be discussed in this poster are listed
below:Infectious / Inflammatory: 1. Otitis externa2. Otitis
media3. Coalescent mastoiditis with orbital involvement4.
Bell’s Palsy5. Guillain-Barre’ syndrome with facial
palsyNeoplastic Lesions: 1. Vestibular schwannoma2.
Rhabdomyosarcoma3. Ewing’s sarcoma4. Langerhan’s cell
histiocytosis5. Osteoblastoma6. Osteoma7. Aggressive
MyofibromatosisVascular: 1. Carotid vasculitis secondary to
petrous abscessMiscellaneous Lesions: 1. Cholesteatoma
(congenital and acquired)2. Cholesterol granuloma
Poster #: EDU-065
Radiographic manifestations and clinical relevance of
central nervous system complications of leukemia in
children
Yan Sun,[email protected]; Shanghai Children's Medical
center, Shanghai, China
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To investigate the radiological
findings of central nervous system complications of leukemia
(CNSCL)in children.
Methods & Materials: The CT and MR findings and clinical
features of 49 pediatric patients with CNCSL were
retrospectively analyzed.
Results: (1) Cerebrovascular abnormalities in 23 cases included
hemorrhage(n=20), infarction(n=2) and sinus thrombosis(n=1).
1 case of epidural hematoma and 19 cases of intracerebral
multiple bleeding were seen in the hemorrhage group, which
demonstrated high-density on CT and different signal on MR as
time went by. Microhemorrhage displayed as low signal on
susceptibility weighted imaging (SWI). (2) Among 23 cases of
leukemic infiltration, dura and/or skull were involved in 18
cases, which presented as fusiform or mass, with high density
on CT, low signal on T1WI, intermediate signal on T2WI and
strong enhancement. 6 leptomeningeal infiltration demonstrated
as meningeal thickening and enhancement. 2 parenchymal
involvement manifested with high-density mass. 2 oculomotor
nerve and 1 optic nerve infiltration demonstrated thickening and
enhancement .(3)White matter disease were seen in 2 case,
with hyper-intensity on T2WI.(4) one case of secondary tumor
is glial tumor of brainstem.
Conclusions: The radiographic manifestations of CNCSL in
children are various. CT and MR are of important diagnostic
values. SWI is suggested as routine modality because of
sensitivity of hemorrhage, which is of practical significance to
clinical politics.
Poster #: EDU-066
Introduction to the Technical Aspects of PET/MRI with
Clinical Applications to Pediatric Neuroradiology for
Residents and Fellows
Alex Chan, D.O.1, [email protected]; Brady
Laughlin, D.O.1, Rachael Latshaw, DO1, Waqas Abid1, Alberto
Iaia, M.D.1, Parham Moftakhar, M.D.1, Vinay V. Kandula,
M.D.2, Rahul Nikam, M.D.2, Arabinda Choudhary, M.D.2; 1Diagnostic Radiology, Christiana Care Health System, Bear,
DE, 2Nemours/Alfred I. duPont Hospital for Children,
Wilmington, DE
Disclosures: Arabinda Choudhary, M.D.: Consult, Honoraria:
Child Abuse Lectures, Equity Interest/Stock Options: GE
Shares. All other authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: PET/MRI has recently become a
clinical realization after overcoming complex hardware and
image reconstruction issues. The goal of this educational exhibit
is to provide a comprehensive, yet understandable, introduction
to these aspects of PET/MRI along with displaying a pictorial
assay of different normal and abnormal metabolic findings
within the field of Pediatric Neuroradiology.The first part of this
presentation will begin by highlighting the basic hardware
components of the PET/CT contrasting with the interactions
between the main components of the PET/MRI scanner along
with their associated solutions. In general, these issues include
how MRI can affect PET in terms of their magnetic field and
RF properties and how PET affect MRI due to the
scintillator/electronic components.The second part will begin by
discussing some soft tissue and hardware attenuation correction
techniques that are currently in use, such as: Segmentation and
atlas-based methods along with attenuation map generation and
coil localization methods. Additionally, we will show the
consequence of field-of-view (FOV) mismatch between the PET
and MRI acquisitions and partial volume effects along with their
solutions.The final part will showcase clinical applications of
PET/MRI to Pediatric Neuroradiology, featuring imaging
protocol details and a pictorial guide of normal distributions and
pathologic conditions. Clinical examples range from seizure
localization, cortical malformations, manifestations of
Phakomatoses, perinatal stroke, tumor recurrence, and
Flutriciclamide (18F-GE180) imaging in the setting of
neuroinflammation.
Poster #: EDU-067
CT and MRI of pediatric skull base
Rukya Masum, MD, [email protected]; Chanae
Dixon, MD, Maura Ryan, MD, Alok Jaju, MD; Radiology,
Lurie Children's Hospital, Chicago, IL
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: This review describes the CT and
MRI features of developmental variants and pathological lesions
that involve the skull base, excluding those centered in the nasal
cavity, nasopharynx, sinuses and orbits.Normal anatomy of
developing bony skull base will be illustrated. The lesions are
categorized by pathology rather than locations, and the
following entities will be covered.Congenital and
developmental lesions - arrested pneumatization, aberrant
arachnoid granulations, dermoid/epidermoid cysts, ecchordosis
physaliphora, encephaloceles, persistent craniopharyngeal
canalInflammatory/Infectious lesions - skull base osteomyelitis,
petrous apicitis, cholesterol granulomaBenign lesions - Fibrous
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S173
dysplasia, aneurysmal bone cyst, osteoma, osteochondroma,
meningiomaMalignant lesions - Langerhans cell histiocytosis,
lymphoma, neuroblastoma metastasis, Ewing’s sarcoma,
osteosarcoma, chordoma, chondrosarcoma
Poster #: EDU-068
Inclusion of the Transfontanelle Doppler as a Staple of
Neonatal Head Ultrasound
Michael Collard, MD, [email protected]; Jeannie
Kwon, Kate Louise M. Mangona, MD, Cory Pfeifer; Children's
Medical Center, Dallas, TX
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Head ultrasound has long been
utilized in the first few months of life to screen neonates for
hemorrhage, assess midline anatomy, characterize extra-axial
fluid collections, elucidate causes for suspected
ventriculomegaly, and serially evaluate parenchymal
echotexture without exposing the child to ionizing radiation or
the expense of MRI. Less commonly utilized in a routine
fashion is Doppler interrogation of the midline vasculature as
part of the inpatient routine head ultrasound protocol. This
exhibit will educate the reader on how and when transfontanelle
Doppler can be utilized and the benefits it can provide.
Methods & Materials: The routine use of transfontanelle
Doppler interrogation of the intracranial vasculature is
described. Using medical illustrations and relevant images from
patient exams, the correct positioning and acquisition of images
is shown. A review of the relevant anatomy is performed.
Correlation of ultrasound abnormalities with MRI results is
provided. Use in patients undergoing ECMO is highlighted.
Pitfalls and tips to improve imaging are described. Comparisons
to transcranial Doppler are made using correlational diagrams.
Results: The transfontanelle Doppler can provide valuable clues
to diagnosis. Abnormal resistive indices can have prognostic
value in the setting of hypoxic ischemic encephalopathy and for
patients on extracorporeal membrane oxygenation. Specifically,
abnormally low resistive indices in the perinatal period have
been shown to have a positive predictive value of 71% for
adverse outcomes. Doppler has also been shown to add value to
ultrasound evaluation of patients with known brain damage,
whether due to ischemia, infection, or hemorrhage. Extra-axial
fluid collections can affect Doppler values. Interestingly, in
patients who have had recent cardiac surgery, elevated resistive
indices have been shown to be associated with improved
neurodevelopmental outcomes.
Conclusions: Transfontanelle Doppler has been shown to add
valuable information in multiple clinical scenarios.
Transfontanelle Doppler evaluation is feasible with little
additional training and should be performed as part of the
routine head ultrasound protocol on inpatient neonates.
Poster #: EDU-069
Imaging spectrum in pediatric focal cortical dysplasia
(FCD) on MR and FDG-PET imaging with correlation to
surgical pathology based on ILAE classification.
Pankaj Watal, [email protected]; Sarv Priya, MD,
T. Shawn Sato, Girish Bathla, DMRD FRCR; University of
Iowa Hospitals and Clinics, Iowa City, IA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: 1. Review of structural and metabolic
imaging findings across various classes of FCD based on recent
ILAE classification.2. Review of correlation between imaging
findings and pathologic features in different FCD groups.
Methods & Materials: The review is based on retrospective
evaluation of pediatric patients who underwent surgery for
treatment of medical refractory epilepsy at our institution
between 2000 and 2018. The inclusion criteria were presence of
at least one pre-operative optimal quality MR imaging (1.5T or
3T) exam of brain dedicated to epilepsy evaluation and interictal
FDG-PET brain study within past 1 year of surgery. Patients
with presence of mMCD (mild malformation of cortical
development) including microdysgenesis and neuronal
heterotopia were also included. Patients with pathology proven
isolated epileptogenic neoplastic lesions, isolated hippocampal
sclerosis or nonspecific gliosis were excluded.
Results: The search of institutional radiology database showed
20 patients who met our criteria. 2 patients were excluded
because of suboptimal imaging exam (either MRI or FDG-PET
brain). Out of the 18 patients, no patients were noted under
ILAE pathologic Class Ia, IIIb and IIIc. The ILAE class with
most number of patients was IIIa (FCD with hippocampal
sclerosis), MR imaging in all of them demonstrated
hippocampal sclerosis but was negative or equivocal for FCD;
the FDG-PET in this group appeared to correlate better with
distribution of FCD on surgical pathology. No transmantle sign
was noted in this pediatric population, although this could be
due to small sample size. 2 patients had underlying tuberous
sclerosis evident on MR imaging and showing diffuse
hypometabolism reflecting global pathology. 2 patients had
mMCD with unremarkable MRI exams and focal abnormalities
on FDG-PET corresponding to area of pathology.
Conclusions: The use of information from both MRI and FDG-
PET can help in identifying the epileptogenic zone better in
FCD. The FDG-PET appears more sensitive than MRI in type I
FCD. The structural imaging has higher specificity and can
characterize FCD lesions of type II and III better.
Poster #: EDU-070
Dermoid cysts in the suprasternal notch: focus on initial
sonographic diagnosis
Jose Molto, [email protected]; Judyta Loomis, Tara
Cielma, Matthew Whitehead, MD; Radiology, Children’s
National Medical Center, Washington, DC
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Dermoid cysts are a sequestration of
ectoderm containing secondary skin structures, usually at
characteristic locations of embryologic fusion lines. The
midventral suprasternal fusion line is one such location in the
developing embryo with both simple and complicated dermoids
of this region reported in the literature. We reviewed our
academic pediatric institutional experience with dermoid cysts
of the suprasternal notch, focusing on the initial presentation as
a palpable nodule referred for sonographic evaluation.The
purpose of this educational exhibit is to depict the ultrasound
imaging features of suprasternal notch dermoid cysts in the
pediatric population.Secondary purposes are to describe the
anatomy of the suprasternal notch, demonstrate CT and MR
correlates of the these dermoids, and depict regional
inflammatory complications.
Methods & Materials: 47 retrospective cases aged from 2
months to 13 years were collected utilizing an electronic
database of radiology reports at our academic children’s
hospital from January 2008 to July 2018. Many cases were
confirmed either with typical MR appearance or excisional
biopsy.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S174
Results: Suprasternal notch dermoid cysts demonstrate specific
sonographic findings:(1) circumscribed ovoid mass located
between the sternornohyoid muscles in the midline(2)
longitudinal orientation(3) homogeneously echogenic with some
of them showing small internal anechoic areas(4) posterior
acoustic enhancement(5) absence of internal Doppler blood
flow
Conclusions: Characteristic location of a nodule in the
suprasternal notch and specific sonographic findings allow for a
confident radiologic diagnosis of a dermoid cyst without the
need for additional imaging.
Poster #: EDU-071
Basic Physics of ASL with Clinical Applications to Pediatric
Neuroradiology
Alex Chan, D.O.1, [email protected]; Brady
Laughlin, DO1, Waqas Abid1, Rachael Latshaw, DO1, Alberto
Iaia, M.D.1, Parham Moftakhar, M.D.1, Rahul Nikam, M.D.2,
Vinay V. Kandula, M.D.2, Arabinda Choudhary, M.D.2; 1Diagnostic Radiology, Christiana Care Health System, Bear,
DE, 2Nemours/Alfred I. duPont Hospital for Children,
Wilmington, DE
Disclosures: Arabinda Choudhary, M.D.: Consult, Honoraria:
Child Abuse Lectures, Equity Interest/Stock Options: GE
Shares. All other authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: The goal of this educational exhibit
is to use a graphical and image heavy Powerpoint presentation
to familiarize the reader with the background necessary to
understand common clinical ASL-PWI imaging techniques
along with displaying a pictorial assay of different normal and
abnormal ASL perfusion findings within the field of Pediatric
Neuroradiology.To introduce our topic, we will briefly discuss
the physiology of cerebral blood flow and how it is measured
with and without an exogenous tracer. Next, to serve as an
overview, we will show the general ASL experiment, namely,
labeling, post label delay, and readout. Following, we will
discuss each of the above components, beginning with showing
the different main labeling methods, CASL, PCASL, and PASL.
Finally, the concept of post label delay will be illustrated
respective to each of the main labeling methods.In the second
section, we will discuss the image acquisition component by
first describing and illustrating two common readout methods,
such as 2D-EPI and 3D-GRASE methods along with their
advantages and disadvantages. Additionally, we will illustrate
the process of background suppression along with its
significance. Finally, we will review the process of obtaining
perfusion weighted images through the subtraction between
tagged and control images.The third section will illustrate an
assortment of clinical examples beginning with showing normal
physiological hyper- and hypoperfusion and newborn perfusion
characteristics. Following, we will highlight a spectrum of
clinical cases including: moyamoya, HIE, medullary infarct
with luxury perfusion, arteriovenous malformation, PRES,
infections (intracerebral abscess, toxoplasmosis, cerebellitis),
characteristics of headache, intracranial tumors (juvenile
astrocytoma, hemangioblastoma, ATRT, and choroid plexus
papilloma), cortical dysplasia, tuberous sclerosis with seizures,
and variations presentations of methotrexate toxicity. Lastly, we
will discuss cerebral blood reserve imaging utilizing
acetazolamide challenge. All cases will contain pertinent
clinical information and images from other
sequences/modalities that aid in the diagnosis of disease.
Poster #: EDU-072
Congenital structural MRI findings in epilepsy
Amy Farkas, MD, [email protected]; Niki Patel, David
Joyner; University of Mississippi Medical Center, Jackson, MS
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Epilepsy can be a progressive and
debilitating illness in the pediatric population. There is a large
range of congenital conditions that present with seizures in
neonatal patients, which are essential for the radiologist to
accurately characterize on imaging. Accurately diagnosing the
cause of epilepsy can not only allow appropriate treatment, but
also provide important information on prognosis and associated
abnormalities.The goal of this educational poster is to provide
an overview of different congenital etiologies of epilepsy. This
case based review includes congenital malformations of the
brain such as focal cortical dysplasia, schizencephaly,
heterotopias, hemimegalencephaly, and polymicrogyria. Cases
highlighting neurocutaneous conditions associated with epilepsy
including tuberous sclerosis and Sturge-Weber are reviewed.
Cortical injuries from insults such as congenital infection,
hypoxic-ischemic injury, or hemorrhage are also
included.Familiarity with the imaging findings of epilepsy is
essential for the radiologist, especially the trainee and those
with less experience with pediatric neuroimaging. After
reviewing this educational poster, viewers will be able to
describe the imaging features of congenital causes of epilepsy
and understand the treatment and prognoses of these conditions.
Poster #: EDU-073
Imaging of Pediatric olfactory system anomalies
Schoenbrun Lori, MD1, [email protected];
Subramanian Subramanian1, Deepa S. Rajan, MD1, Jenna
Gaesser, MD1, Cecilia W. Lo, PhD2, Vincent Schmithorst,
PhD1, Ashok Panigrahy, MD1; 1Radiology, Children's Hospital
of Pittsburgh, Pittsburgh, PA, 2University of Pittsburgh,
Pittsburgh, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Understanding anatomy and
embryology is crucial for evaluation of olfactory epithelium,
olfactory nerve, olfactory bulb and olfactory cortex pathology.
We will discuss various imaging modalities available to
evaluate olfactory system and discuss role of fMRI and
Diffusion tensor imaging of olfactory system. Fetal MRI can
identify olfactory bulb and olfactory sulci after 30weeks of
gestation consistently and can be helpful in diagnosis of charge
syndrome. Various congenital CNS malformations associated
with olfactory system abnormalities like CHARGE,
Holoprosencephaly, Kallmann syndrome, Acrocallosal
syndrome, frontal encephalocele and sphenoidal encephalocele
will be presented. Traumatic injury to cribriform plate of
ethmoid can result in transection of olfactory nerve resulting in
anosmia. Primary tumors of olfactory epithelium,
esthesioneuroblastoma and secondary involvement of olfactory
epithelim by rhabdomyosarcoma will be presented. Various
tumors that can involve olfactory cortex namely DNET,
ganglioglioma and pilocytic astrocytoma will be
presented.References:Booth TN, Rollins NK. Spectrum of
clinical and associated MR findings in children with olfactory
anomalies. Am J Neuroradiol.2016; 37:1541-48Blustajn J,
Krisch CFE, Panigrahy A, Netchine I. Olfactory anomalies in
CHARGE syndrome: Imaging findings of a potential major
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S175
diagnostic criterion. Am J Neuroradiol.2008; 29:1266-69.
Poster #: EDU-074
Imaging Transcranial Doppler in the Pediatric Neurocritical
Care Unit: Principles and Applications
Chen Yin, M.D., [email protected]; Cory Pfeifer, Rebekah
Clarke; Radiology, University of Texas Southwestern Medical
Center, Dallas, TX
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: There are 2 types of transcranial
Doppler ultrasound. In the non-imaging technique, vessels are
identified and interrogated based on sound, waveform, and
sample depth, often using a transorbital window. The imaging
technique involves the use of color Doppler to visualize the
vessels themselves, commonly via a transtemporal window.
Non-imaging transcranial doppler has long been used as
diagnostic tool to assess for intracranial vasospasm in critically
ill adults. Imaging transcranial Doppler is a common tool used
in the surveillance of children with sickle cell anemia to
evaluate for risk of stroke. This presentation describes the use of
the imaging transcranial Doppler technique to monitor the
intracranial circulation in critically ill children in neurocritical
care setting.
Methods & Materials: A review of the limited available
literature is performed. Indications for the exam are detailed.
The technique used to acquire images and the protocol used are
described. Velocities, direction of flow, and waveforms are
discussed. The template used to report the results is reviewed.
The relationship of the major vessels to the probe is depicted
graphically. Recommendations in the use of this technique to
determine brain death are noted.
Results: A 3V sector probe is used with transtemporal and
transforaminal approach to interrogate the Circle of Willis
including the middle cerebral artery, anterior cerebral artery,
posterior cerebral artery, distal internal carotid artery, basilar
artery and vertebral arteries. Mean velocities and pulsatility
indices are recorded. Detection and evaluation of the
hemodynamic effects of severe stenosis or occlusion of the
extracranial (greater than or equal to 60% diameter reduction)
and major basal intracranial arteries (greater than or equal to
50% diameter reduction) are possible. Transcranial Doppler has
the advantage of providing real-time evaluation of cerebral
vasculature without the use of contrast agents, ionizing
radiation, or sedation.
Conclusions: Imaging transcranial Doppler can be a useful
diagnostic aid in the approach to managing treatment in the
pediatric neurocritical care unit.
Poster #: EDU-075
Ultrasonographic approach of neck masses in the pediatric
population.
Mariangeles Medina Perez, MD, [email protected];
Saurabh Gupta, MBBS, Zain Badar, MD, Ninad Salastekar,
MBBS, MPH, Anand Majmudar, MD; Radiology, SUNY
Upstate Medical University, Syracuse, NY
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Neck masses are commonly seen in
the pediatric population and are a frequent reason for pediatric
consults and can represent a diagnostic challenge. Although
there is a broad spectrum of differentials, the vast majority of
these lesions are benign, however malignant etiologies can also
be encountered. Ultrasonography has become the first-line
imaging modality in the evaluation of neck masses, given the
ability to avoid radiation, wide availability and cost-
effectiveness. Also, ultrasound represents an option when trying
to avoid contrast administration or sedation.The main teaching
points of this exhibit will be:1. Review variety of congenital and
acquired neck masses in the pediatric patients.2. Discuss
imaging features and approach to various vascular, congenital
abnormalities, benign and malignant tumors and other acquired
abnormalities with Ultrasound.3. Discuss the role of anatomic
imaging in management.A case-based pictorial review will be
used to demonstrate:1. Approach to vascular tumors and
malformations based on clinical and imaging features including
congenital, infantile hemangioma, low flow, various types of
vascular malformations, locally aggressive lesions like
kaposiform hemangioendothelioma, malignant tumors likely
angiosarcoma and hemangioendothelioma.2. Reviewing salient
features of various congenital and acquired abnormalities
including branchial cleft cysts, thyroglossal duct cysts,
congenital goiter and midline frontal masses.3. Discuss imaging
features of other benign and malignant masses including
teratomas, primary cervical neuroblastomas, soft tissue tumors
(myofibroblastic), lipoblastoma. Also malignant tumors like
fibrosarcoma, rhabdomyosarcoma.4. Describe masses which
mimic tumors such as fibromatosis coli and ectopic thymus.5.
Treatment and prognosis.
Poster #: EDU-076
When Poland Met Mobius: a Hyperlucent Hemithorax
Should Prompt MRI of the Brain
Xiaozhou Liu, MD, [email protected]; Akshita Mehta,
MD, Cory Pfeifer; Radiology, University of Texas
Southwestern, Coppell, TX
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Poland Syndrome is a classic
differential consideration for a unilateral hyperlucent
hemithorax on chest radiograph due to pectoralis aplasia or
hypoplasia. Additional associations include brachysyndactyly,
simian crease, dextrocardia, and liver/biliary abnormalities.
Isolated pectoral hypoplasia or aplasia without limb
involvement is generally cosmetic and can be corrected with
plastic surgery, but Mobius syndrome should be ruled out due to
its association. Children with Mobius syndrome can exhibit an
expressionless affect, excessive drooling, and/or eye paralysis
due to cranial nerve deficiencies. This educational exhibit
discusses the pediatric radiologist's role in the imaging approach
to these supposedly separate diseases which may represent a
continuum of one pathology.
Methods & Materials: The epidemiological, clinical, genetic,
and imaging findings of both Poland syndrome and Mobius
syndrome are described. A discussion of the appropriate
protocol required to aid in the diagnosis of Mobius syndrome is
included. Differential diagnoses are explored. Radiologic
examples of additional associations such as morning glory
syndrome and Pierre-Robin syndrome are also depicted.
Results: Poland syndrome can occur sporadically, but some
familial associations have been observed. It is more common in
males and more commonly affects the right side of the body.
Mobius does not appear to exhibit a gender predominance. Like
Poland syndrome, the disease commonly occurs sporadically,
though associated genetic mutations have been characterized.
Imaging findings include cranial nerve hypoplasia or aplasia.
Due to the association between these diseases, the name Poland-
Mobius syndrome is sometimes uses. In the child presenting
with Poland syndrome, MRI of the brain with high resolution
imaging of the cranial nerves is indicated.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S176
Conclusions: Poland syndrome and Mobius syndrome, though
both rare, can occur in tandem. The pediatric radiologist should
be aware that the diagnosis of either disease should prompt
assessment for the other. High resolution imaging of the cranial
nerves is indicated when Poland syndrome is diagnosed.
Poster #: EDU-077
The Imaging Saga of Growth Disturbances in the Pediatric
Population
Aayushi Rai, [email protected]; Rachita Gupta,
Medical Student, Bindu Setty, MD; Boston Medical Center,
Boston, MA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: The pituitary gland, the epicenter of
various regulatory hormones, plays an unquestionably important
role in determining timely growth and sexual maturation.
Indeed, multiple studies have examined the role of Growth
Hormone (GH) and Gonadotrophic Releasing Hormone (GnRH)
in treating delayed and precocious puberty
respectively.[1]Research has shown the importance of imaging
the pituitary gland in patients with growth disturbances and/or
documented endocrine abnormalities, in differentiating and
classifying disorders based on etiology, prognosis and
management.[2] Currently, data are limited in identifying a
correlation between bone age abnormalities and pituitary
findings via MRI, in children diagnosed with deviations in
pubertal development. We present a comprehensive review of
common structural abnormalities affecting the pituitary as seen
on MRI – including developmental (dysgenesis/hypoplasia),
traumatic, and neoplastic processes (both benign and malignant)
– and how those pituitary lesions correlate with bone age and
endocrine function in patients with growth failure and
precocious puberty. Establishing a correlation between a
patient’s endocrine profile, bone age and pituitary morphology
on MRI imaging can be extremely useful in the judicious
management of patients, in terms of patient selection, early
diagnosis and treatment. Moreover, our review aims to highlight
the importance of imaging in the workup of patients with known
or suspected growth disturbances, illustrated via concept maps.
The concordance of endocrine abnormalities and clinical
information (including age, sex and ethnicity demographics)
with imaging data will also be reviewed to demonstrate various
patterns of disease presentation and diagnosis.References:[1]
Du X.F., Yang X.H., Li J., Hao M., Guo Y.H. Growth hormone
co-treatment within a gnrh agonist long protocol improves
implantation and pregnancy rates in patients undergoing IVF-
ET. Arch. Gynecol. Obstet. 2016;294:877–883. doi:
10.1007/s00404-016-4163-1.[2] Di Iorgi N, Iorgi ND, Allegri
AEM et al (2012) The use of neuroimaging for assessing
disorders of pituitary development. Clin Endocrinol 76:161–176
Poster #: EDU-078: Withdrawn
Poster #: EDU-079
The Many Faces of Brainstem Anomalies
Sean Creeden, MD, [email protected]; Hisham M.
Dahmoush, MD, Carolina Guimaraes, MD; Stanford University,
Stanford, CA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Brainstem anomalies pose a
diagnostic challenge for trainees to even the most advanced in
their practice. Our exhibit aims to provide a comprehensive
review of these rare disorders which are being diagnosed earlier
and more frequently utilizing advanced imaging and genetic
sequencing techniques. Representative images of these disorders
with key distinguishing features will be presented. Familiarity
with these conditions will benefit practicing radiologists,
radiologists in training, and our clinical colleagues.
Methods & Materials: A diagnostic imaging approach to
brainstem anomalies using high quality representative images
with emphasis on MRI, including fetal MRI, will be presented.
Results: 1) Review the appropriate stages of brainstem
development.2) Highlight a number of cases demonstrating
brainstem anomalies including tubulinopathies,
dystroglycanopathies, ciliopathies, cri-du-chat syndrome,
pontocerebellar hypoplasia, Aicardi-Goutieres syndrome,
patterning defects, pontine tegmental cap dysplasia and other
rare disorders.3) Provide key distinguishing imaging features
for these malformations.
Conclusions: This review aims at familiarizing radiologists
with complex and challenging cases of brainstem
maldevelopment from in-utero to post-natal presentation. Early
and accurate diagnosis are key to meaningful outcomes and
future planning. It is important for neuroradiologists and
pediatric radiologists alike to retain a wide range of differential
diagnoses thus providing diagnostic confidence when potential
future cases are encountered.
Poster #: EDU-080
Imaging of Conductive Hearing Loss in Children: A
Pictorial Review
Diana Rodriguez, MD,[email protected]; Nationwide
Children's Hospital, Columbus, OH
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To review the embryology and
anatomy of the temporal bone, with emphasis in the external
and middle ear.To describe the imaging findings of common
and rare pathology of conductive hearing loss within the
pediatric population.
Methods & Materials: We retrospectively reviewed CT and
MR examinations between Jan 2010 and Oct 2018 of patients
undergoing imaging for evaluation of conductive hearing loss.
We identified subjects with normal temporal bones, as well as
subjects with various pathology causing conductive hearing
loss.
Results: Normal anatomy of the external and middle ear.
Diverse pathology of the external and middle ear was
encountered.Cases were categorized into the following
groups:A. Congenital: External auditory canal atresia, oval
window atresia, congenital ossicular anomalies and fixation,
congenital cholesteatoma, fenestral otosclerosis, persistent
stapedial artery, fibrous displasia, and osteopetrosis.B.
Acquired: External auditory canal exostosis, otitis externa, otitis
media, cholesteatoma, trauma, and neoplasm such as
Langerhans Cell Histiocytosis.
Conclusions: We have demonstrated the normal anatomy of the
temporal bone, with emphasis in the external and middle ear, as
well as pertinent imaging findings of both common and more
rare causes of conductive hearing loss in children.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S177
Poster #: EDU-081
Pictorial Review of Pitfalls in SPECT-CT I-123 MIBG
Imaging of Neuroblastoma
Lillian Lai, MD, [email protected]; Rachel Berkovich,
Fariba Goodarzian; Children's Hospital Los Angeles, Los
Angeles, CA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: The purpose of this exhibit is explore
pitfalls in our experience with SPECT-CT Iodine-123 (I-123)
MIBG imaging in patients with neuroblastoma. SPECT-CT can
more specifically localize areas of uptake over planar imaging
and mitigate false-positive results with correlative anatomic
information. We will review cases of false-positive MIBG
uptake in nonmalignant sites, cases of false-negative MIBG
uptake in neuroblastoma/neural crest tumors, and cases of
secondary tumors/malignancies occurring in the setting of
known neuroblastoma, with variable uptake on MIBG.
Methods & Materials: Pictorial, retrospective review of key
false positive and false negative cases of I-123 MIBG uptake in
neuroblastoma imaging.-Review of normal MIBG uptake and
excretion-Significance of SPECT positive but planar negative
findings on Curie score-Imaging artifacts (misalignment/mis-
coregistration, etc.)-Physiologic cases of false positive increased
uptake in benign/non-malignant sites
(glomerulonephritis/pyelonephritis, renal vein thrombosis,
remaining unilateral adrenal gland, brown fat, thyroid gland,
skeletal muscles, lungs, liver. Additional false positive uptakes
localizing to previously treated neuroblastoma and representing
post-surgical changes.-Explore false negative MIBG uptake in
neuroblastoma or neural crest tumors (i.e. ganglioneuroma and
metastatic neuroblastoma liver lesions showing little to no
uptake.) Key Point: Non-MIBG avid neuroblastoma may
require troubleshooting with 18F-DOPA or 18F-FDG PET-CT.-
Review cases of secondary tumors/malignancies occurring in
the setting neuroblastoma, with variable uptake on MIBG
(Increased MIBG uptake in renal cell carcinoma and medullary
thyroid carcinoma; no MIBG uptake in myofibroma of the jaw
and a mucoepidermoid salivary gland tumor.) Key
Point: Suggest further dedicated imaging and correlation with
tissue sampling if a lesion is suspected clinically.
Results: A pictorial review of false positive and false negative
cases at SPECT-CT I-123 MIBG imaging of neuroblastoma
patients will be discussed. SPECT-CT may help localize areas
of uptake and minimize false-positive results.
Conclusions: Recognizing pitfalls during SPECT-CT I-123
MIBG imaging of neuroblastoma patients will help radiologists
correctly interpret findings and help guide proper treatment and
management.
Poster #: EDU-082
All that's hot is not malignant: A review of non-malignant
pathology on pediatric PET/MRI
Akash Patel, M.D., [email protected]; Lisa States;
Children's Hospital of Philadelphia, Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: With the increased demand and
utilization of PET/MRI in oncologic imaging, there is an ever
increasing database of non-malignant pathology that has not yet
been described on PET/MRI. Furthermore, the pediatric
population provides an even more unique breadth of pathology
that is often only seen in this age group. It is important to be
able to accurately identify these common pathologies so as to
not mistake them for malignancy and to prevent unnecessary
follow up imaging studies and further invasive diagnostic
procedures.For this educational exhibit we review over 200
clinical pediatric 18F-FDG PET/MRs performed at our
institution and highlight the most common and most interesting
cases of FDG-avid non-malignant pathology.Listed below are
some of the cases to be included in the poster:-Benign FDG avid
bone tumors including non-ossifying fibromas-Benign causes of
FDG avid lymphadenopathy including cat scratch disease-
Benign causes of FDG avid lung lesions including aspiration
pneumonia-Benign causes of gastro-intestinal FDG uptake
including pseudomembranous colitis-Benign FDG avid
infectious pathologies including a liver abscess
Poster #: EDU-083
Imaging of Post-Transplant Lymphoproliferative Disease
and its Complications
Alexis B. Maddocks, MD, [email protected];
Edward P. Fenlon, MD, Susie Chen, MD, Carrie Ruzal-Shapiro,
MD, Diego Jaramillo, MD MPH; Columbia University Medical
Center-Morgan Stanley Children’s Hospital, New York, NY
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Post-Transplant Lymphoproliferative
Disease (PTLD) is a polyclonal and monoclonal lymphoid
proliferation which occurs in 1-20% of solid organ transplant
recipients. It is most common in multivisceral organ transplants
followed by small bowel transplants, heart and lung transplants
and less commonly in liver and kidney transplants. PTLD has a
bimodal distribution of occurrence with the largest peak
occurring within 1 year after transplantation and a second peak
at approximately 4-5 years after transplantation. The Epstein
Barr virus (EBV) is associated in 50-70% of cases. EBV
seronegativity in the recipient at the time of transplant predicts a
2-4 times increased risk of PTLD especially if they receive a
donor organ which is positive for EBV. This may explain the
higher incidence in the pediatric population who tend to be
seronegative for EBV. The World Health Organization (WHO)
identifies four pathologic categories of PTLD: early lesions,
polymorphic type, monomorphic type and classic Hodgkins
lymphoma. The majority of PTLD cases are caused by B-
lymphocyte proliferation in a T-cell depleted environment in the
setting of immunosuppression. However, there is a subset of
cases that are caused by T-cell or natural killer cells as well as
cases that occur in the setting of negative EBV. Multiple clones
of proliferating B-cells can be seen in a single patient. 2/3 of
cases have diffuse expression of CD20 which is an important
target for therapy.PTLD may be focal or diffuse and can
manifest in a variety of different organ systems or even in the
allograft itself. There is a higher percentage of extranodal
disease in PTLD as compared to immunocompetent patients
with lymphoma. The GI tract and liver are most commonly
involved. Isolated lymph node involvement in comparison is
less common in patients with PTLD. Central nervous system
(CNS) involvement is relatively rare in PTLD.This educational
exhibit will provide a pictorial review of PTLD and illustrates
cases from one of the busiest transplant centers in North
America to highlight the major imaging findings as well as
complications seen on imaging of this disease. Extranodal and
nodal disease will be demonstrated on multiple modalities as
well as complications of this disease including intussusception
and biliary obstruction. CNS disease will also be shown. The
clinical manifestations, imaging characteristics, prognosis and
treatment will be discussed and depicted.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S178
Poster #: EDU-084
Pediatric Oncologic Emergencies: Recent Updates in
Pediatrics that the Radiologist Needs to Know
Atsuhiko Handa1, [email protected]; Taiki
Nozaki2; 1Radiology, University of Iowa, Iowa City, IA, 2St
Luke's International Hospital, Tokyo, Japan
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Children with cancer are at increased
risk of life-threatening emergencies, either from cancer itself or
related to cancer treatment. These conditions need to be
assessed and treated as early as possible to minimize their
morbidity and mortality. Cardiothoracic emergencies
encompass a variety of pathologies, including (1) pericardial
effusions and cardiac tamponade, (2) massive hemoptysis, (3)
superior vena cava syndrome, (4) pulmonary embolism, and (5)
pneumonia. Abdominal emergencies include (6) bowel
obstruction, (7) intussusception, (8) perforation and tumor
rupture, (9) intestinal graft-versus-host disease, (10) acute
pancreatitis, (11) neutropenic colitis, and (12) obstructive
uropathy. Radiological imaging plays a vital role in the
diagnosis of these emergencies. Although imaging features have
been described in most of these conditions, recent advancement
in clinical pediatrics is fast-paced. In this educational exhibit,
we aim to review the clinical and imaging features of pediatric
oncologic emergencies including a review of the recently
published literature. Key radiological images are presented to
highlight the radiological approach to the diagnosis.
Pediatricians, pediatric surgeons, and pediatric radiologists need
to work together to arrive at the correct diagnosis and to ensure
prompt and appropriate treatment strategies.
Poster #: EDU-085
An Updated Approach to Pediatric Abdominal Tumors
LeAnn M. Shannon, MD, [email protected]; Sudha
Singh, MD; Radiology, Vanderbilt University Medical Center,
Mount Juliet, TN
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: With research pushing ever onward,
it is often difficult to keep pace with the dynamic landscape of
pediatric abdominal tumors and their classification systems.
However, it is imperative that we, as radiologists, remain
vigilant of these changes, as our initial and follow-up imaging
assessments often have the potential to drive clinical
intervention in widely differing directions.In this educational
poster, we will review the most up-to-date risk stratification and
staging criteria for neuroblastoma, hepatoblastoma, and Wilms
tumor in order to:1. Educate about the most recent criteria for
categorizing pediatric abdominal tumors such as neuroblastoma,
hepatoblastoma, and Wilms tumor.2. Provide imaging examples
of these pediatric abdominal tumors and describe how the
above-mentioned criteria might change radiology reports and
patient management.3. Encourage accurate risk stratification of
these tumors so that radiologists are better equipped to assist in
directing appropriate patient care.
Poster #: EDU-086
Breaking Ondine's Curse: The Pediatric Radiologist's Role
in Congenital Central Hypoventilation Syndrome
Elisabeth Moredock2, [email protected];
J. M. Fulmer, MD2, Michael Collard, MD1, Cory M. Pfeifer,
MD1; 1Diagnostic Radiology, University of Texas Southwestern
Medical Center, Dallas, TX, 2Baylor University Medical Center,
Dallas, TX
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Congenital Central Hypoventilation
Syndrome (CCHS) is a rare disorder that can cause respiratory
arrest during sleep. It is sometimes referred to as "Ondine's
Curse" in reference to a fictional character who had to
remember to breathe based on a spell cast by a jilted lover. The
number of cases has been reported to be near 1,000. The
purpose of this educational exhibit is to describe CCHS and
emphasize its implications for pediatric radiology.
Methods & Materials: The molecular basis and incidence of
CCHS are described. Neoplastic associations and additional
abnormalities are emphasized. The effects on multiple organ
systems are discussed.
Results: CCHS is caused by a mutation in PHOX2B. The
product of this gene is found in neural crest cells and promotes
neuron formation and differentiation. Most cases of CCHS
occur from spontaneous mutation, but the disease can be
inherited in an autosomal dominant fashion. Due to its neural
crest involvement, CCHS predisposes patients to neuroblastoma
which prompts regular screening by oncologists. Likewise,
neural developmental failure can result in Hirschsprung disease
requiring barium enema for evaluation. Patients often have a
short wide face. Treatment sometimes involves the use of a
diaphragmatic pacer which may be unfamiliar to radiologists.
Conclusions: CCHS is rare, but the diagnosis prompts
screening for neuroblastoma which is more common in this
disease. Barium enema is indicated early in life to exclude
Hirschsprung disease.
Poster #: EDU-087
Dicey DNA: DICER1 Syndrome and its Implications for
Pediatric Radiologists
Jay R. Coleman, MD, [email protected]; Michael
Collard, MD, Cory M. Pfeifer, MD; Diagnostic Radiology,
University of Texas Southwestern Medical Center, Dallas, TX
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Molecular biology has come to the
forefront of modern oncology. Knowledge of specific genetic
mutations within tumors drives prognostic information and can
guide therapy. Keeping up with new terminology in oncology
can be difficult for pediatric radiologists who often host
oncology conferences and present regularly at grand rounds.
The purpose of this educational exhibit is to describe DICER1
syndrome and discuss its implications for pediatric radiology.
Methods & Materials: Basic information regarding the
molecular basis for tumor promotion is presented. The DICER1
gene and its product are described. Neoplastic associations with
DICER1 are emphasized. The effects on multiple organ systems
are discussed.
Results: The DICER1 gene encodes a protein that controls
production of micro RNA molecules (miRNA). miRNA serves a
regulatory role in gene expression by binding messenger RNA
(mRNA). Messenger RNA is the intermediary between the
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S179
genetic information encoded by DNA and the proteins and
enzymes that eventually produce phenotypes. The DICER1
product thus serves as a policeman of sorts, and common
DICER1 mutations result in a dysfunction and loss of regulation
which increases the likelihood that a neoplastic process will
ensue. Most individuals with a DICER1 mutation do not
develop cancer, but the risk is increased. Pleuropulmonary
blastoma is a primary concern in DICER1 syndrome. Cystic
nephroma is also a common association. Sertoli-Leydig cell
tumors and multinodular goiter are seen in patients with
DICER1syndrome. Pineoblastoma and pituitary blastoma are
seen with specific DICER1 abnormalities.
Conclusions: DICER1 syndrome is a cancer predisposition
condition that can affect multiple organ systems. Understanding
the function of this gene is essential to appreciating its
associated disease processes.
Poster #: EDU-088
PET/MR of pediatric bone tumors: What the radiologist
needs to know
Crystal R. Farrell, MD, [email protected]; Anuj Pareek,
MD, Anne M. Muehe, MD, Allison Pribnow, MD, Robert
Steffner, MD, Raffi S. Avedian, MD, Heike E. Daldrup-Link,
MD, PhD; Stanford University, Palo Alto, CA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: PET/MR is a valuable and growing
imaging method for the assessment and management of
pediatric bone tumors. Although plain radiography remains the
first line modality for initial evaluation, cross sectional imaging
is often required for further characterization of indeterminate or
aggressive appearing lesions. Due to its superior soft tissue
contrast resolution compared to CT, MR has become the
mainstay in tissue characterization, locoregional staging, and
surgical planning of pediatric bone tumors. By adding
functional and metabolic information, FDG-PET imaging is
useful for “one stop” local tumor and whole-body staging,
evaluating response to therapy and surveillance. 18F-FDG
PET/MR scans have the benefit of lower radiation and increased
patient convenience compared to 18F-FDG PET/CT scans.
However, due to the relatively recent development of this
technology, many radiologists may be unfamiliar with the
technical considerations and interpretation pearls and pitfalls of
PET/MR. This educational exhibit reviews the imaging
technique, reporting requirements, and imaging characteristics
of the most common pediatric bone tumors with 18F-FDG
PET/MR.
Methods & Materials: We conducted a comprehensive
literature search on 18F-FDG PET/MR of pediatric bone tumors
and have included the most current evidence-based information
for review. We also present our institutional approach and
experience with performing 18F-FDG PET/MR scans of
pediatric bone tumors.
Results: We describe the imaging technique and reporting
criteria for conducting 18F-FDG PET/MR scans of bone tumors
in children and young adults. We review the epidemiology,
pathology, 18F-FDG PET/MR imaging characteristics, and
treatment monitoring approaches for the most common pediatric
bone tumors, including osteosarcoma, Ewing sarcoma, primary
bone lymphoma, bone and bone marrow metastases, and
Langerhans cell histiocytosis. We also discuss various potential
“false positive” bone lesions, and some important similarities
and differences between 18F-FDG PET/MR and 18F-FDG
PET/CT. Finally, we provide insight into the future directions
and developments of this new technology.
Conclusions: Familiarity with 18F-FDG PET/MR in the
evaluation of pediatric bone tumors is of growing importance.
This review covers the 18F-FDG PET/MR imaging features of
the most common pediatric bone tumors, as well as technical
considerations, reporting methods, and future possibilities for
performing “one stop” 18F-FDG PET/MR cancer staging of
children and young adults.
Poster #: EDU-089
PET/CT Evaluation of Pediatric Lymphoma: A
Classification System Review
James Leake, MD, [email protected]; Cory
Pfeifer; Radiology, UT Southwestern, Dallas, TX
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Lymphoma (including both
Hodgkin’s and non-Hodgkin’s) is the third most common
pediatric malignancy. Treatment requires distinct definitions of
bulky disease, response to therapy, and organ involvement. In
this way, pediatric radiologists form a center role in the medical
care of affected children. This educational exhibit examines
pediatric lymphoma diagnosis and response to therapy by
detailing the varying classification systems, including the newer
PET-related Deauville and Lugano classification systems.The
Ann Arbor staging classification system for Hodgkin’s
lymphoma was initially developed in the 1970’s and
anatomically classifies lymphoma by site and number of lymph
nodes affected, cross-diaphragmatic disease, and extralymphatic
organ dissemination. More recently, after the introduction of
PET/CT, newer classification systems which incorporated tumor
metabolism were developed - including Deauville and Lugano.
Notably, these systems are commonly applied to both
Hodgkin’s and non-Hodgkin’s lymphoma. This educational
exhibit includes a discussion of these various systems as well as
annotated examples. Additionally, risk stratification is discussed
using strata defined by the Children’s Oncology Group (COG),
EuroNet, and Pediatric Hodgkin Consortium.After review, the
pediatric radiologist should feel more comfortable staging and
classifying response to treatment of lymphoma using PET
assessment principles.
Poster #: EDU-090
Childhood Interstitial (Diffuse) Lung Disease: A Pattern
Recognition Approach to Diagnosis in Infants
Teresa Liang, MD BSc, [email protected]; Edward
Lee, MD, MPH; Boston Children's Hospital, Boston, MA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Childhood interstitial (diffuse) lung
disease (chILD) in infants consists of a rare and heterogeneous
group of disorders previously classified with clinical, radiologic,
and pathologic features. The purpose of this article is to discuss
imaging techniques and provide a pattern-based approach for
chILD in infants.
Methods & Materials: 1. Review the current American
Thoracic Society (ATS) guidelines for diagnosis and
classification of chILD2. Discuss the utility and limitations of
imaging modalities including radiographs, CT and MRI for
diagnosis and follow up of chILD in infants3. Review a CT
pattern-based approach with imaging examples for chILD in
infants
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S180
Results: After reviewing the exhibit, the reader will be aware of
the spectrum of chILD in infants, and be able to use the
discussed imaging based algorithm to assist in efficient and
accurate diagnosis of various chILD entities in the infant
population.
Conclusions: chILD in infants constitutes a diverse group of
lung abnormalities which can be complex and challenging to
diagnose. Aside from the infants with diffuse development
disorders, whom typically are only imaged with chest
radiographs, the remainder of the diseases in the chILD
spectrum presenting in infants can be approached with a CT
algorithm utilizing the stepwise assessment of lung volumes,
ground glass, and cysts. In conjunction with the patient’s
demographics and clinical presentation, this algorithm can aid
the radiologist in making an accurate and timely diagnosis.
Poster #: EDU-091
Standardization of Postnatal CT Imaging and
Interpretation of Bronchopulmonary Malformations (BPM)
Beverley Newman, MD,[email protected]; Stanford
University, Stanford, CA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: BPM’s are often identified
prenatally; while some have more detailed imaging and
description, many are loosely called congenital pulmonary
airway malformations (CPAM). A chest radiograph is usually
obtained at birth, but CT imaging is often deferred until 3-
6months of age in asymptomatic babies, when surgical removal
is being considered. Participation in a presurgical conference
has indicated that there is poor standardization of both
performance and interpretation of CT for BPM’s. High quality
studies are most often hampered by poor timing of imaging,
poor vascular opacification and obscuration of pathology due to
atelectasis. There are four key internal feature of BPM’s that
help with lesion characterization, differential diagnosis and
management decisions. These include: systemic arterial supply;
bronchial mucoid impaction; overinflated lung and macroscopic
cysts. Reliable recognition and description of these features in
all cases is essential for guiding surgical decisions since some
lesions can be treated conservatively, especially those with just
hyperinflation and mucoid impaction. A feature that tends to be
overlooked is mucoid impaction, indicative of bronchial atresia.
Cystic changes and overinflated lung may be mischaracterized.
Small systemic arteries can be missed. Multiplanar
reconstructions and interaction with maximum intensity
projections and a 3D dataset are very helpful. This poster aims
to educate by providing multiple illustrative imaging examples
and a standardized report template useful for radiologists,
clinicians, research and registries.
Poster #: EDU-092
There is MAGEC going on in Ultrasound
Amy Winer,[email protected]; Ultrasound, Cincinnati
Children's Hospital, Cincinnati, OH
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: 1.To identify what are MAGEC rods
and how ultrasound is utilized in the lengthening procedure to
reduce the number of x-rays that they are exposed to.2. To
describe the use of Ultrasound to aid with lengthening the
MAGEC rods in Scoliosis patients.3. Decscribe the pros and
cons of Ultrasound use.
Methods & Materials: Scoliosis is a sideways bending or
curvature of the spine. At times, surgical intervention is required
to help correct or stop the curvature from getting worse. By
using the MAGEC rods, this can reduce the number of surgeries
and radiation from xrays that a patient is exposed to.Ultrasound
is used to help measure the growth of the growing rods at each
lengthening and reduce the number of xrays that the patient is
getting. In this poster, I will discuss the procedure of performing
an lengthening of the MAGEC rods and the benefits and
downfalls of ultrasound.
Results: What is scoliosisTreatment of scoliosisMAGEC rods-
what is it?How do they workAnatomy of the rodsUsing
Ultrasound as a measuremen toolBenefit of Ultrasound
usageDownfalls of Ultrasound usage
Conclusions: Using Ultrasound to help with the lengthening
MAGEC rods can save a patient from the exposure or xrays
along with reducing the number of surgeries that a patient will
need in their lifetime.
Poster #: EDU-093
The Pediatric Breast: When to Worry
Rimpi Saini, MD1, [email protected]; Joshua D.
Wermers, DO1, Shelby Larson1, Grace Mitchell, MD2, Amy
Patel, MD1; 1Radiology, University of Missouri Kansas City,
Kansas City, MO, 2Children's Mercy Hospital, Kansas City,
MO
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: With an incidence of 3.25%, breast
masses in the pediatric population are a relatively rare
phenomenon. Despite this, breast masses are a substantial
source of anxiety and concern for parents and patients alike,
largely due to the increased awareness of breast cancer in the
adult population. Fortunately, the vast majority of masses are
benign, and pediatric breast malignancies constitute less than
1% of all pediatric malignancies. Moreover, malignancy tends
to be secondary to metastatic disease from lymphoma,
leukemia, or rhabdomyosarcoma, as primary breast carcinoma is
exceedingly rare. Although initial sonographic characteristics of
breast masses may be nonspecific, recommendation for further
evaluation with biopsy and/or excision of the mass is usually
not recommended due to the rarity of malignancy, and
avoidance of disrupting immature breast parenchymal tissue. In
adults, the Breast Imaging-Reporting and Data System
classification is quite accurate for dictating management
recommendations. However, this system grossly over-
emphasizes the risk of malignancy in pediatric patients, as
imaging findings are usually discordant with histology.
Currently, there are no standardized guidelines for management
recommendations of pediatric breast masses, and short-term
follow-up ultrasound is usually recommended to evaluate for
malignant potential. The purpose of this educational exhibit is to
compare the sonographic abnormalities of breast pathologies
arising from normal breast development, including but not
limited to gynecomastia, mastitis, and abscesses, from those
arising from neoplastic processes including fibroadenomas,
hemangiomas, arterio-venous malformations, and phyllodes
tumors. In addition, the current literature on management
recommendations, including indications for MRI and
biopsy/excision of breast masses, will be reviewed. Finally, this
exhibit will discuss the important role pediatric radiologists play
in understanding the epidemiology and natural history of breast
pathologies, enabling accurate characterization of masses and
appropriate treatment recommendations to further guide patient
management.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S181
Poster #: EDU-094
Imaging Findings in Pleuropulmonary Blastoma and the
DICER1 Mutation
Rosario Carrasco, MD, [email protected]; Rebecca Hulett-
Bowling, MD; Pediatric Radiology, St. Louis Children's
Hospital, St. Louis, MO
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Pleuropulmonary blastoma (PPB) is
a rare, intrathoracic, malignant tumor in the pediatric population
with approximately 500 cases reported worldwide. Over 90% of
these cases are in patients below the age of 6. The spectral
morphology of PPB is used to classify the lesions along a
continuum from the least malignant to the most malignant: type
I (cystic) 14%, type II (solid and cystic) 48%, and type III
(solid) 38%. Congenital lung cysts are not known to degenerate
to become PPB, but the cystic type I PPB may progress to the
more aggressive type II or type III PPB. In addition, PPB is
associated with cystic nephroma in 30% of cases, and has been
linked to the DICER1 mutation which puts these patients at risk
for other tumors. For example, the genetic basis of the PPB
familial syndrome (which is the heterozygous loss of function
mutation of DICER1) includes PPB, cystic nephroma, ovarian
Sertoli-Leydig cell tumors, ciliary body medulloepithelioma,
nodular hyperplasia and differentiated carcinoma of the thyroid
gland, pituitary blastoma, pineoblastoma, nasal
chondromesenchymal hamartoma, and cervical embryonal
rhabdomyosarcoma.The purpose of this educational report is to
demonstrate various presentations and identify distinguishing
features of each type of PPB as seen on initial radiographs with
correlation on subsequent CT scans. Only cases where the PPB
and type were confirmed by pathology are included. At least
one case of the PPB familial syndrome will also be presented.
Positive DICER1 mutations will be provided when available, as
this information is increasingly used to aid in the treatment
decisions. Early recognition of PPB with timely investigation
for cystic nephroma and DICER1 mutations can lead to
improved patient outcomes.
Poster #: EDU-095
TB or not TB: The Pediatric Radiologist's Role in
Diagnosing Mycobacterial Infections
Ali Alian, M.D., [email protected]; Cory Pfeifer;
University of Texas Southwestern Medical Center, Dallas, TX
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: In 2017, children under the age of 15
accounted for only 10% of the 10 million Mycobacterium
tuberculosis (TB) infections estimated by the World Health
Organization. Child carriers of TB pose health risks to their
adult caregivers, and children can exhibit greater susceptibility
to significant health risks from the infection. Nontuberculous
mycobacterial (NTM) infection presents disparate health risks
and can generate imaging specific findings. This presentation
addresses radiologic manifestations of mycobacterial disease as
a means to educate pediatric radiologists given the medical
significance of mycobacterial infection.
Methods & Materials: This exhibit will discuss how children
may manifest TB infections differently than adults and describe
imaging findings of pulmonary and extra-thoracic TB infection
in children. Contrasting findings in multi-system NTM infection
will also be detailed. The presentation will provide radiologic
manifestations of verified mycobacterial infection and
emphasize unique characteristics of mycobacterial infection.
Results: Pulmonary TB in children may present with diffuse
pulmonary disease and/or pleural effusions that can appear more
impressive than the clinical presentation seemingly suggests.
Extra-pulmonary TB can cause brain abscesses, osteomyelitis,
and intra-abdominal infection which have distinct appearances
compared to typical bacterial infections. Pathogenic NTM
organisms include Mycobacterium avium-intracellulare,
Mycobacterium kansasii, Mycobacterium xenopi,
Mycobacterium fortuitum, and Mycobacterium chelonae. MTB
commonly infect the soft tissues and cervical lymph nodes as
well as the lungs. The radiologic and clinical presentation of
mycobacterial infection often depends on the immune status of
the child. Mycobacterial recovery is often complicated by
inability to obtain a sufficient biologic specimen and lack of
growth on routine contrast media. For this reason, pediatric
radiologists play a key role in raising appropriate management-
guiding concerns for disease.
Conclusions: Mycobacterial infection can present differently in
children. Radiographic findings suggestive of pediatric TB
should prompt testing in relevant contacts.
Poster #: EDU-096
Big bubbles, little bubbles, bubbles everywhere: A review of
macro and microcystic lymphatic malformations in less
common anatomical locations.
Marian Gaballah, D.O., [email protected]; Rachelle
Goldfisher, MD; Zucker School of Medicine at
Hofstra/Northwell, New Hyde Park, NY
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Lymphatic malformations (LMs) are
low-flow vascular malformations which are composed of dilated
lymphatic channels, forming septated cyst-like structures (2).
LMs are the second most common type of vascular
malformation, second to venous malformations (1). The most
common locations are in the neck, followed by the axillary
region. On MRI, LMs are multiloculated, T2 hyperintense
lesions, which may have fluid-fluid levels, and are without flow
voids (1, 2). They can involve multiple tissue planes and do not
regard anatomical and fascial boundaries (2). Cystic lymphatic
malformations are further divided into microcystic, macrocystic,
or mixed, based on the size of their cystic components.
Macrocystic LMs are composed of larger cysts, while
microcystic LMs are composed of smaller cysts and may appear
solid on imaging.We present ten cases of microcystic,
macrocystic, and mixed lymphatic malformations in a variety of
anatomical locations. In addition to demonstrating the imaging
findings, we present a review of the literature in regards to each
anatomical region. Lymphatic malformations in this
presentation include right orbit (n=1), mediastinum (n=2),
pulmonary bronchovascular bundles/pleural space (n=1),
retroperitoneum (n=1), mesentery (n=2), perirectal and scrotal
(n=1), lower extremity (n=2). 6 of these children also had
additional sites of T2 hyperintense disease involving the bones
or spleen, suggestive of additional lymphangiomas.This
presentation summarizes ten cases of lymphatic malformations
in a variety of less common anatomical locations and a review
of the pertinent literature.References:1. Flors L, Leiva-Salinas
C, Maged IM et al. (2011) MR Imaging of Soft-Tissue Vascular
Malformations: Diagnosis, Classification, and Therapy Follow-
up. Radiographics 31:1321-1340.2. White CL, Olivieri B,
Restrepo R et al. (2016) Low-flow vascular malformation
pitfalls: from clinical examination to practical imaging
evaluation- part 1, lymphatic malformation mimickers. AJR
206: 940 – 951.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S182
Poster #: SCI-001
Pediatric Dose Evaluation of 4D Dynamic CT Protocol
Mohammed H. Aljallad, PhD,
[email protected]; Brian S. Dunoski, MD;
Children's Mercy Hospital, Kansas City, KS
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Balancing PEEP settings in
mechanically ventilated premature infants to maximize air
exchange while minimizing barotrauma is typically evaluated
using bronchography. A 4D dynamic airway computerized
tomography protocol (4D CT) was developed as a less invasive
method to evaluate large and small airways collapse at variable
PEEP settings. Our purpose was to evaluate the radiation dose
from 4D CT and to demonstrate the number of cycles impact on
the radiation dose.
Methods & Materials: 39 pediatric patients <5 years who
underwent imaging as part of routine clinical care between
1/1/16-10/1/18. Dynamic sequential CT scan was performed on
Siemens Flash, fixed 70 kVp, fixed 10 mAs. One 4D CT
imaging cycle was defined as the time required for one full
inspiratory-expiratory cycle at a given PEEP, which ranged
between 2-8 seconds. Each cycle contained 7 rotations. The
body and skin effective radiation doses were estimated using
two methods: (1) the body effective dose is calculated using
Monte Carlo simulations of a library of male and female
anthropomorphic size and age-specific phantoms. (2) NanoDots
optically stimulated luminescent dosimeters were used to
measure the peak skin dose (PSD) by placing them on the chest
of a newborn phantom for a different number of cycles.
Results: Increasing the number of cycle/rotations increased the
PSD, dose length product (DLP), effective dose, and the lung
organ dose. The estimated effective dose varied depending on
the patient’s DLP value, patient’s gender, and age weighting
factors. The average effective dose was higher for female
patients. From the simulation’s results, the highest organ dose
was received by the lungs. The average value for lung dose was
0.9 mSv.
Conclusions: Irradiation over the same anatomic region by 4D
CT results in accumulation of radiation dose and raising the
concern for the potential deterministic effect of skin injury. The
maximum measured entrance skin exposure by the 4D CT was
orders of magnitude lower than the threshold dose for early
transient erythema (2000 mGy). As the PSD increased by
increasing the number of rotations, reducing the number of
imaging cycles may reduce the overall patient radiation
exposure. A differential effective dose in female patients is due
to higher end-organ risk from radiation scatter. Extra caution to
limit cycles should be exercised when using 4D CT technique in
children under 1 year. In addition, DLP would be a better dose
metric than CTDI because of DLP metric account for the total
irradiated area.
Poster #: SCI-002
Delayed Phase Imaging in Pediatric Trauma: A review of
the literature and experience in a Level I Trauma Center
Zachary E. Stewart, MD1, [email protected]; Kate
Elmore2, Allison Thompson, MD1, Huy Pham1; 1Diagnostic
Radiology, Memorial Health University Medical Center,
Savannah, GA, 2Mercer University School of Medicine,
Savannah, GA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Delayed phase imaging increases the
sensitivity of detection of injuries to the urinary tract and also
assists in characterizing solid visceral organ injuries at the
expense of doubling the radiation dose to the patient. If
institutions can lower the rate of these examinations, the
cumulative radiation exposure reduction would be substantial.
Here we evaluate the rate of delayed phase imaging in the
pediatric trauma population at our Level I trauma center as well
as the frequency with which these patients demonstrate an
indication on portal venous imaging for delayed phase
acquisition. Finally, there are minimal guidelines dictating the
appropriateness of delayed imaging in pediatric trauma. We
include a review of the literature in order to elucidate
appropriate indications and help guide clinicians to make
evidenced based decisions.
Methods & Materials: A retrospective chart review was
performed analyzing data of pediatric (0-18 years) trauma
activations at our institution with a CT chest/abdomen/pelvis,
between January 1 2016-January 1 2018. The primary variable
analyzed was acqusition of delayed imaging. Indications for
delayed imaging on portal venous phase imaging, including
solid organ injury, pelvic fracture, and free fluid, were also
reviewed. Given the potential for physiologic free fluid in post-
pubescent girls, data was also analyzed excluding free fluid as
an indication in girls older than 12 years old.
Results: 134 patients met the inclusion criteria. Delayed
imaging was acquired in the majority of patients (91%, n=122).
There was a near even split for presence/abscence of an
indication for delayed imaging on the portal venous phase
imaging. There was no statistical correlation with an indication
for delayed imaging and the acquisition of delayed imaging
(p=0.475). When accounting for each indication independently,
there was no statistical correlation between a specific indication
and acquisition of delayed imaging.
Conclusions: We found no correlation between indication for
delayed-phase imaging and its acquisition in pediatric trauma
patients at our Level I trauma center. Delayed phase imaging
was obtained in the vast majority of these patients, irrespective
of indication. Improving referral education and adoption of a
protocol in which delayed imaging is only obtained in pediatric
patients with appropriate indications could reduce the effective
radiation dose to the pediatric trauma patients at our instition by
25%. Review of the literature corroborates these findings.
Poster #: SCI-003
Improving Collimation in Pediatric Chest Radiographs
Cory Pfeifer, MD,[email protected]; Diagnostic
Radiology, University of Texas Southwestern Medical Center,
Dallas, TX
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Given the relative sensitivity of
pediatric patients to radiation, the need to limit exposure to the
region of interest is of the utmost importance in pediatric
radiography. This study assesses the practice of acquiring
pediatric chest radiographs at a community hospital in which the
imaging contract was acquired by a radiology practice with
subspecialty-certified pediatric radiologists. Pediatric
radiologists in the new radiology practice saw a need for
improved collimation of pediatric chest radiographs at the
community hospital. Many radiographs exhibited poor
collimation and included much of the abdomen. This study
examines an initiative to measure and improve radiograph
quality.
Methods & Materials: All pediatric chest radiographs (n = 50,
average age 5.6 years) obtained at the community hospital
during 4 consecutive weeks were reviewed. The following
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S183
method was employed to assess collimation: a horizontal line
was drawn across the image at the level of the inferior border of
the lower hemidiaphragm, an “optimal” vertebral body level
was assigned by allowing 1 vertebral body height below the line
for patients 5 years and younger (0.5 vertebral body heights for
patients older than 5 years), and comparing this to the actual
lowest vertebral level included in the film. After analysis of the
control group was complete, an in-service was provided at the
community hospital in which the proper and expected technique
was reviewed with the technologists.
Results: In the initial analysis of films in the pre-intervention
group, an average of 1.72 extra vertebral levels were included
on 49 frontal radiographs analyzed. A single film was excluded
due to over-collimation meaning that both costophrenic angles
were not included. Of the 39 lateral films obtained in the control
period, an average of 1.33 extra vertebral levels were included.
Of the lateral films, 2 were excluded due to over-collimation.
Conclusions: Reducing unnecessary x-ray exposure to children
through the use of an inservice program is achievable.
Poster #: SCI-004
A More Reasonable Approach to ALARA: Emergent
Contrast-Enhanced CT Results in Lower SSDE at an
Academic Children's Hospital
Joseph Cao, [email protected]; Cory Pfeifer; Radiology,
UT Southwestern, Dallas, TX
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: The principle of ALARA and its
application in the pediatric population serves as the focus of the
Image Gently campaign. Tertiary care institutions dedicated to
the care of children are well situated to be regional leaders in
maximizing the ALARA concept. This study compares the size-
specific dose estimates of computed tomography (CT) studies
performed at our institution to those from outside facilities
referring patients for emergent care.
Methods & Materials: Our institution, a major pediatric
referral center, is a large academic pediatric hospital that
performs approximately as many CT exams of the abdomen and
pelvis with contrast for acute abdominal pain as it receives
consult requests for CT exams performed at referral centers.
The SSDE of 20 consecutive contrast enhanced CT exams of
the abdomen and pelvis performed at our institution were
calculated and compared to 20 consecutive CT exams of the
abdomen and pelvis with contrast submitted from outside
referral facilities over the same time period. Size specific dose
estimates (SSDE) of CTs of the abdomen and pelvis were
calculated using established reference ranges based on patient
size as defined by the AAPM1.
Results: The mean SSDE for patients scanned at our institution
was 10.31 (95% CI: 9.49-11.13). The mean SSDE for exams
performed on studies at outside referral facilities was 28.12
(95% CI: 17.15-39.10). The average age and patient body size
of our patient population were statistically similar.
Conclusions: These findings demonstrate that there is a
significant decrease in SSDE of CT studies performed at our
institution compared to outside referral institutions. This finding
is important in highlighting the successful application of the
optimization principle of ALARA at our institution.
Furthermore, the degree of SSDE variability among referral
institutions is important in showing that the choice of facility is
likely a major determinant in radiation dose to children in the
region. Outside facilities may benefit from additional training
regarding dose optimization techniques in the pediatric
population.
Poster #: SCI-005
Bismuth breast shields for pediatric patients undergoing CT
chest, abdomen, and pelvis: the benefits
Joshua H. Finkle, MD1, [email protected]; Emily
Marshall, PhD2, Ingrid Reiser2, Yue Zhang, PhD2, Zheng Feng
Lu, PhD2, Anji Jones, BS, RT(C)2, Kate A. Feinstein2; 1Medical
Imaging, Ann & Robert H. Lurie Children's Hospital of
Chicago, Chicago, IL, 2University of Chicago Medicine,
Chicago, IL
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Global mAs reduction is accepted as
being superior to bismuth breast shields in reducing breast organ
dose for children undergoing CT of the chest. However, in
imaging of chest, abdomen, and pelvis (CAP), globally reducing
mAs degrades image quality in the abdomen and pelvis. This
study compares bismuth shields to global mAs reduction
including a region-specific boost feature to maintain abdominal
image quality.
Methods & Materials: CT CAP was performed on three
phantoms of varying sizes, using three different techniques.
First, each phantom was scanned with a bismuth breast shield.
To establish dose savings, a control scan was performed with
the same technique as the shielded scan but with the breast
shield removed. Each phantom was scanned a third time without
a shield but with global mAs reduction enabled to match image
quality at the heart established during the shielded scan.
Parameters for the third scan included a liver region boost
feature to improve image quality in the abdomen. Entrance skin
exposure was measured at the anterior and posterior chest, with
the anterior measurement representing breast organ dose. Image
quality was assessed using standard deviation measurements in
the heart and liver regions.
Results: In the smallest phantom (water-equivalent diameter,
WED 16.6 cm), the breast shield provided greater breast dose
savings (14%) than global mAs reduction (7.6%) at the same
image quality. In the larger two phantoms (WED 23.5 and 28.9
cm, respectively), breast dose savings with the breast shield
(20.6% and 18.7%) were comparable to those when using global
mAs reduction with the liver boost enabled (18.6% and 18.9%),
with similar image quality in the heart and liver.
Conclusions: For small patients and for scanners without
region-specific boost features, breast shields provide the best
dose savings while maintaining abdominal image quality and
therefore should be used for all CT CAP protocols. In larger
patients with access to scanners with these advanced dose
modulation methods, global mAs reduction can be used to
achieve similar results to breast shields.
Poster #: SCI-006
Improved Understanding of Radiologic Appropriateness
Among Pediatric Residents via Radiologist-Driven
Didactics
Cory Pfeifer, Samantha Castillo, MD,
[email protected]; Radiology, University of Texas
Southwestern Medical Center, Hurst, TX
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: This study evaluates the value of
radiologist-driven imaging education in a pediatric residency
program. The primary goals of this educational program were to
provide pediatric residents with resources such as the American
College of Radiology Appropriateness Criteria, support optimal
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S184
resource utilization and patient care, increase resident
understanding of radiation risk, and determine the value of
integrating radiologists into pediatric education.
Methods & Materials: A needs assessment was performed in
which the chief residents of a large pediatrics program were
surveyed. The consensus of chief residents was that a 4-part
lecture series delivered by a pediatric radiologist would be
beneficial to pediatric residents. Topics included general
radiation risk as well as basic imaging topics in the chest,
abdomen, neurologic system, extremities, and vasculature. Each
lecture integrated appropriate ordering, ALARA/Image Gently,
and basic image interpretation. Pediatric residents were given a
10-item quiz before and after the lecture series assessing their
knowledge regarding the best test to order in clinical scenarios.
Residents were also asked, using a Likert scale, to rate their
understanding of radiation risk, the ACR Appropriateness
Criteria, and other topics of interest before and after each
lecture.
Results: A total of 79 unique surveys were collected from a
program of 92 residents. Chief residents reported that most
residents were able to attend at least 2 lectures. The average pre-
lecture score for knowledge of radiation risk was 3.27 (95% CI:
3.02-3.51) out of 5 which improved to 4.27 (95% CI: 4.09-4.57)
post-lecture. There was a further increase in understanding of
ACR appropriateness, with pre-lecture rating of knowledge
increasing from 1.91 (95% CI 1.54-2.29) out of 5 to 3.61 (95%
CI 3.33-3.90) post-lecture. Other areas of notable improvement
included understanding of appropriate imaging orders for
neurologic pathology (2.61 to 4.06 pre- and post-lecture) and in
the abdomen/pelvis (2.78 to 4.17 pre- and post-lecture).
Residents also provided positive subjective feedback upon
conclusion of the program and reported a beneficial effect on
their education.
Conclusions: A radiologist-driven lecture series in a pediatric
residency can improve resident understanding of appropriate
ordering practices and radiation risk. Radiologist participation
in pediatric residency training is well-received. Future
directions for research could include evaluation of the rate of
appropriateness compliance.
Poster #: SCI-007
Right ventricular pulmonary regurgitation and two
dimensional right ventricular strain in repaired Tetralogy of
Fallot in children
Rong-Zhen Ouyang, Master, [email protected]; Yumin
Zhong, Chen Guo, Li-Wei Hu, master; Radiology, Shanghai
Children's Medical Center, Shanghai Jiao Tong University,
School of Medicine, Shanghai, China
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Many patients with repaired
Tetralogy of Fallot (TOF) have right ventricular (RV) volume
overload due to pulmonary regurgitation (PR)and would have
ventricular deformation as time goes by after repaired surgery.
We studied the effect of pulmonary regurgitation on global and
regional right ventricular (RV) deformation, and their
relationships with conventional diagnostic parameters.
Methods & Materials: Cases of repaired Tetralogy of Fallot
with the duration time of 5-15years between surgery and cardiac
magnetic resonance(CMR) were enrolled. The main pulmonary
regurgitation fraction(PRF), RV volume and RV ejection
fraction(RVEF), RV three segments (basal, mid, apical) of
radial, circumferential and longitudinal strain were analyzed on
CVI46(Circle Vascular Imaging, Canada). Independent Sample t
test and Pearson correlation were used to analyze the
parameters. RVEF is equal or greater than 54% was considered
as normal value.
Results: Twenty repaired Tetralogy of Fallot were enrolled in
this study, 8 girls and 12 boys, duration time is 10.27±3.52
years. RV basal, mid and apical radial strain were 19.71±9.54
(%),19.39±6.84(%)and 37.28±14.92(%) respectively.
RVbasal, mid and apical circumferential strain were -
11.39±3.89(%), -12.00±3.65(%) and –18.10±4.90(%)
respectively. RV global longitudinal strain was -11.18±3.29(%).
There was no correlation between PRF and RV strain but RV
end diastolic volume (RV EDVi) and stroke volume(RVSVi).
Duration time had obvious negative correlation with LVEF but
positive correlation with RV EDVi and RV end systolic volume
(RV ESVi). Each segment radial and circumferential strain had
obvious correlation.
Conclusions: Pulmonary regurgitation fraction will cause right
ventricular volume overload and ventricular deformation. RV
strain was not found to have correlation with right ventricular
volume overload and ventricular deformation in this small
group study, but more cases need to be enrolled and control
group should be include to compare which will be continued to
study.
Poster #: SCI-008
Clinical Applications of Coronary CT Angiography in
Preclinical Coronary Abnormalities in Children
Sharon W. Gould, MD, [email protected]; M. P.
Harty, MD, John W. Ostrowski, MD, Takeshi Tsuda, MD;
Medical Imaging, Nemours/A.I. duPont Hospital for Children,
Wilmington, DE
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Diseases of the coronary arteries are
rare in children, but can present as unexpected catastrophic
events without preceding symptoms. It is essential to identify
patients at risk to prevent potentially serious cardiovascular
events. Coronary CT angiography (CCTA) has been widely
studied in adults, but its clinical applications are not well
established in children.
Methods & Materials: Retrospective chart and image review
of coronary artery computed tomographic angiography from
2016 - 2018 was conducted to assess 1) image quality, 2)
unexpected events, and 3) radiation dose.
Results: A total of 32 cases of CCTA were performed in our
hospital from January 2016 to May 2018 (from 0.5 to 30 years
of age; median 12). Indications for CCTA include 1) congenital
coronary anomalies (n = 12), 2) after arterial switch operation (n
= 10), 3) other congenital heart disease (n = 6), and 4)
miscellaneous (n = 4). All patients had a diagnostic
echocardiogram. Although a few, initial studies were performed
on a 64 slice scanner, most of the studies were performed using
a 2 x 128 slice dual source scanner. High-pitch, prospectively
gated, adaptive, prospectively gated, and dose modulated,
retrospectively gated techniques were utilized depending upon
the patients’ heart rhythms. Exposure parameters, kilovolt peak
(kVp) and milliampere-seconds (mAs) were adjusted according
to patient size and body habitus, as well as due to the presence
of metallic chest implants. Three had suboptimal CT images due
to an ectopic beat (1), hiccups (1), and a limited injection rate
(1). Twenty nine cases (91%) showed expected diagnostic
quality: 97% for coronary ostia and 91% for distal segments,
superior to echocardiogram. Average/median radiation dose was
2.83/1.97 mSv, which was improved in 2018 (1.53/1.62 mSv)
after protocol revision.
Conclusions: Coronary CTA provides more reliable image
quality of the coronary ostia and distal segments than
echocardiogram and delineates a distinct spatial relationship
with extravascular structures that angiography cannot. The
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S185
radiation dosage has been significantly reduced with proactive
heart rate control by pre- and intra-procedural use of beta-
blockers, as well as implementation of aggressive protocol dose
reduction techniques. CCTA is a reliable and safe diagnostic
modality in analyzing coronary anatomy in children.
Poster #: SCI-009
Acute Chest Pain and Troponin Leak in Duchenne
Muscular Dystrophy: Comparison with Acute Myocarditis
Using Parametric Mapping
Simon Lee, MD, [email protected]; Rajesh
Krishnamurthy, Ramkumar Krishnamurthy, PhD, Thomas P.
Johnston, Kan Hor, M.D.; Pediatric Cardiology, Nationwide
Children's Hospital, Columbus, OH
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Duchenne muscular dystrophy
(DMD) is a myopathy with a natural history of progressive
cardiomyopathy and vasogenic edema, fatty infiltration, and
myocardial fibrosis. We recently identified a group of patients
with DMD who presented with acute onset of chest pain (ACP),
troponin leak (TL), and new late gadolinium enhancement
(LGE), similar in presentation to acute viral myocarditis (AM).
It is unclear if these patients have suffered an episode of AM or
if this is a different disease process. Given the presumed acute
myocardial necrosis in both processes, we hypothesize that
native T1 and T2 values would be elevated in AM and DMD
patients with ACP compared to asymptomatic DMD patients.
Methods & Materials: This was a retrospective study of three
groups: Group 1: DMD, LV ejection fraction (LVEF) > 55%,
and no LGE; Group 2: DMD presenting with ACP, TL, and new
LGE; Group 3: clinical diagnosis of AM. All patients from
January 2016 to June 2018 with native T1 and T2 mapping
performed during a clinically indicated cardiac MRI study were
included. T1 and T2 mapping was performed at a single mid-
ventricular short axis slice. The slice was divided into a septal,
anterior, and inferior region. All images were post-processed by
a single observer.
Results: LVEF was lower in the Group 3 (p <0.05) compared to
Group 1, with no difference between Group 2 and 3 (p = 0.99).
Native T1 values were elevated in Group 2 (p < 0.01) and
Group 3 (p = 0.02) compared to Group 1 with no difference
between Group 2 and 3 (p = 0.41). However when comparing
T2 values for Group 1 and Group 2, this did not reach statistical
significance (p=0.72) despite their similar age. T2 values for
Group 3 were statistically higher for all segments when
compared to Group 1 (p < 0.01) and approached statistical
significance when compared to Group 2 (p = 0.07). Regional
differences were identified in the native T1 maps, particularly in
the inferior segment.
Conclusions: Patients with DMD who present with ACP, TL,
and new LGE have increased T1 values compared to
asymptomatic DMD patients, and similar to patients with AM.
Increased signal is particularly noted in the inferior and anterior
segments. However their T2 values are similar to the
asymptomatic DMD patients and lower than AM patients.
Although the presentation and clinical course of the DMD
patients with ACP and TL has many similarities to AM, the T2
values suggest a lack of significant myocardial edema. This may
represent a unique and unusual disease process in the natural
history of DMD.
Poster #: SCI-010
Young Becker Muscular Dystrophy patients with Late
Gadolinium Enhancement Demonstrate Left Ventricular
Ejection Fraction Decline in Short Term Follow Up
Thomas P. Johnston,[email protected];
Simon Lee, MD, Ramkumar Krishnamurthy, PhD, Rajesh
Krishnamurthy, Kan Hor, M.D.; Nationwide Children's
Hospital, Columbus, OH
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Cardiomyopathy is the leading cause
of mortality for Becker Muscular Dystrophy (BMD).Risk
stratification is challenging due to the wide variation of
cardiomyopathy onset, progression, and severity; with
cardiomyopathy developing independent of skeletal myopathy
progression. Current guidelines recommend “complete cardiac
evaluation” at ten years of age, but do not specify the type of
imaging modality. We have been performing cardiac magnetic
resonance imaging (CMR) routinely by 10 years of age. We
sought to determine the progression of BMD cardiomyopathy
during the adolescent years among patients who have evidence
of fibrosis by late gadolinium enhancement(LGE).
Methods & Materials: At our center, all BMD patients
undergo CMR when sedation is no longer necessary by age 10
years. We retrospectively reviewed the CMR studies performed
between June 2013 and June 2018. Statistical analysis was
performed using Student’s t-test.
Results: There were 43 BMD patients who underwent 98 CMR
studies with LGE assessment. The average age of the first CMR
study was 15.5±4.8 (range 7-25) years. Of these 27/43 (63%)
patients had negative LGE and 14/43 (33%) had positive LGE
on the first study. The LGE positive group was significantly
older (p<0.001) with average age 19.5±3.1 years (range 16-25
years) compared to 13.5±4 years (range 7-22 years). Patients
who were LGE positive had a lower mean LVEF compared with
LGE negative patients (53.9±11.7% vs 62.6±5.3% p-value <
0.005). 31 patients had serial studies for a total of 72 CMR
studies. Of the LGE negative patients 2/27 (7%) became
positive over a 12 month period. In serial follow up, LGE
positive patients showed a statistically significant decline in
LVEF. Over an interval of 2.6± 1.7 years, LGE positive patients
had a decline in LVEF from 53.9±11.7% to 48.5 ± 10.9 % (p-
value < 0.005).
Conclusions: Our study demonstrates a large number of BMD
patients with occult cardiomyopathy identified by LGE at a
younger age than previously described. Serial studies
demonstrated a significant decline in LVEF and increase in
LVEDVi over an interval of 2.6± 1.7 years. CMR studies should
be considered in BMD patients when sedation is no longer
required. Escalation of medical therapy should be considered for
patients who demonstrate evidence of fibrosis. Larger
longitudinal studies should be considered to better isolate
independent risk factors of cardiomyopathy progression.
Poster #: SCI-011
Fetal MRI in the Prognostication of Prenatally-diagnosed
Omphalocele
Rachel Wise1, [email protected]; Jessica H. Belchos,
MD2, Brian W. Gray, MD1, Lava R. Timsina1, Brandon P.
Brown, MD, MA1; 1Indiana University School of Medicine,
Indianapolis, IN, 2St. Vincent Hospital of Indianapolis,
Indianapolis, IN
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S186
Purpose or Case Report: Frequently diagnosed on prenatal
imaging, including fetal MRI, omphalocele has highly variable
morbidity and mortality. Few prenatal prognostic indicators
have been previously identified. We propose that features found
on fetal MRI can predict morbidity and mortality in patients
diagnosed with omphalocele.
Methods & Materials: We performed a retrospective review of
all patients prenatally diagnosed with omphalocele who
received fetal MRI from 2006-2017 at a single institution.
Thirty neonates met study criteria. Imaging biomarkers
identified on fetal MR included observed-to-expected total fetal
lung volume (O/E TFLV); herniation of stomach, spleen, or
liver; omphalocele size; and number of umbilical cord vessels.
The primary outcome was survival, whether to birth or to
discharge. Bivariate and multivariable regression analyses were
performed.
Results: Seventy percent of patients survived to birth, and
45.2% survived to discharge. On bivariate analysis,
observed/expected total fetal lung volume (O/E TFLV)
correlated with survival to discharge (69 ± 29% vs 39 ± 25% for
survivors vs. non-survivors, respectively (p = 0.007)). 23.1% of
patients with stomach herniation (p = 0.021) and no patients
with a herniated spleen survived to discharge (p<0.001). Liver
herniation on MRI approached, but did not reach, significance
for survival to discharge (53% vs. 81% for survivors vs. non-
survivors, respectively (p=0.06)).On multivariable regression
analysis after controlling for gestational age and gender,
stomach herniation on MRI predicted lower likelihood of
surviving at discharge (Adjusted Odds Ratio: 0.04 [CI: 0.004,
0.557], p=0.016).
Conclusions: Utilizing one of the largest reported series, this
advanced imaging series of omphalocele demonstrates the value
of organ-specific characterization to prognostication. While
identifying liver position has long been recognized as valuable
in predicting outcome, our analysis found predictive value for
spleen and stomach position as well. These markers should be
examined in a larger patient cohort with the goal of creating a
validated set of prognostic imaging biomarkers.
Poster #: SCI-012
Fetal MRI findings in congenital high airway obstruction
syndrome: comparison with the normal fetus
Hidekazu Aoki1, [email protected]; Osamu Miyazaki,
Chief1, Saho Irahara1, Reiko Okamato1, Yoshiyuki Tsutsumi1,
Mikiko Miyasaka1, Haruhiko Sago2, Yutaka Kanamori3,
Yasuyuki Suzuki4, Shunsuke Nosaka1; 1Department of
Radiology, National Center for Child Health and Development,
Setagaya-ku, Tokyo, Japan, 2Center for Maternal-Fetal,
Neonatal and Reproductive Medicine, Nationcal Center for
Child Health and Development, Setagaya-ku, Tokyo, Japan, 3Division of Surgery, Department of Surgical Specialties,
National Center for Child Health and Development, Setagaya-
ku, Tokyo, Japan, 4Department of Anesthesiology and Critical
Care, National Center for Child Health and Development,
Setagaya-ku, Tokyo, Japan
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Congenital high airway obstruction
syndrome (CHAOS) is a rare life-threatening disease and
prenatal diagnosis is essential. Some characteristic features seen
on fetal MRI are well-known: primary lesion (upper airway
obstruction) and secondary changes (dilated trachea,
flattened/inverted diaphragm, enlarged and hyperintense lung).
It is also reported that these secondary changes may be reduced
if tracheoesophageal fistula (TEF) is present. The aim of this
study is to evaluate the accuracy of fetal MRI in the prenatal
diagnosis of CHAOS by comparing results with those of normal
fetuses.
Methods & Materials: The MRI images from eight fetuses
with CHAOS (29±6 weeks’ gestation [mean±SD]) and 37
fetuses with no thorax abnormalities (32±2 weeks) were
assessed retrospectively. The fetuses with CHAOS were
selected from among those who were diagnosed at our
institution from 2006 to 2018 (four CHAOS fetuses with TEF
were also included), and the normal fetuses were selected from
consecutive fetal MRI performed in 2017 and 2018.
Identification of the upper airway was evaluated in both groups
(false negative rate [FNR] in the CHAOS group and false
positive rate [FPR] in the control group). Measurement of
tracheal diameter (TD), craniocaudal/antero-posterior ratio in
the right diaphragm (CC/APR), cardiothoracic ratio (CTR), and
lung-to-liver signal intensity ratio (LLSIR) were also carried out
in both groups. For comparison between the CHAOS group and
the control group, a t-test was used. Also, CHAOS fetuses with
TEF were evaluated in the same way as described above.
Results: Upper airway obstruction could be detected in all
fetuses with CHAOS (FNR=0%), while the upper airway could
not be clearly identified in five fetuses in the normal group
(FPR=13.5%). There was no statistical difference in TD
(3.6±1.0 mm, 3.2 mm±0.5 mm, p=0.13) and LLSIR (2.64±0.68,
2.54±0.66, p=0.35) between the CHAOS group and the control
group. However, CC/APR (4.4±14.1%) and CTR (45.9±7.2%)
in the CHAOS group were significantly lower than those of the
control group (23.3±4.5%, 57.1±3.8%, [p<0.05]). Also, the
same statistical results were obtained for the CHAOS fetuses
with TEF (TD [3.2±1.0 mm, p=0.48], CC/APR [14.5±7.4%,
p<0.05], CTR [50.5±4.0%, p<0.05], and LLSIR [2.74±0.39,
p=0.20]) as well as in all CHAOS patients.
Conclusions: CC/APR and CTR may reflect distension of the
lungs and are more reliable predictors than TD and LLSIR for
prenatal diagnosis of CHAOS, even where airway obstruction is
incomplete (CHAOS accompanied by TEF).
Poster #: SCI-013
Prenatal MR Imaging as a Predictor of Respiratory
Symptoms at Birth for Congenital Lung Malformations
Alexis B. Maddocks, MD1, [email protected];
Rama Ayyala, MD2, Shimon Jacobs1, Russell Miller1, Vincent
Duron, MD1; 1Columbia University Medical Center-Morgan
Stanley Children's Hospital, New York, NY, 2Rhode Island
Hospital-Hasbro Children's Hospital, Providence, RI
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Congenital pulmonary airway
malformations (CPAM), bronchopulmonary sequestrations
(BPS), and hybrid lesions are the most common congenital lung
lesions. They are primarily diagnosed prenatally via ultrasound
and further characterized by MRI. While most affected neonates
are asymptomatic at birth, some may experience varying
severities of respiratory distress requiring intervention. We seek
to develop a prognostic model for prediction of post-natal
outcomes in patients with congenital lung lesions using fetal
MRI calculated observed to expected normal lung volume (O/E
NLV).
Methods & Materials: We did an IRB approved, retrospective
study of patients with congenital lung lesions who underwent
fetal MRI and received pre- and post-natal care at our institution
from 2006 to 2016. 163 cases were referred to our institution for
prenatal diagnosis of CPAM, BPS, or hybrid lesion. 68 of these
patients had prenatal MRI performed at our institution. 8
patients were excluded due to "disappearing" lesion at the time
of MRI or non diagnostic study. Statistical analysis was
performed using Chi-square and Student’s t-test. MRI was
reviewed by 2 pediatric radiologists to determine volume of
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S187
normal lung (NLV), defined as the difference between total lung
volume (TLV) and the volume of the lesion. NLV was
normalized against published lung volumes by gestational age
(O/E NLV). Imaging parameters were correlated with
respiratory outcomes at birth including respiratory symptoms at
birth, need for oxygen supplementation, mechanical ventilation,
and delay in feeding.
Results: Mean gestational age at fetal MRI was 23.3 ± 3.0
weeks with a mean O/E NLV of 0.74 ± 0.26. Mean gestational
age at birth was 38.4 ± 2.7 weeks. 14 of those neonates who had
prenatal MRI had respiratory distress at birth. Requirement for
oxygen supplementation at birth was observed in 12 of those
patients and mechanical ventilation was necessary in the
remaining 2 patients. O/E NLV did not significantly correlate
with symptomatology at birth (p=0.15) or delay in feeding
(p=0.14). O/E NLV did significantly correlate with requirement
for supplementary oxygen (p=0.05) and requirement for
mechanical ventilation (p=0.05) with a mean O/E NLV of 0.62
± 0.17 and 0.4 ± 0.005 respectively.
Conclusions: Fetal MRI calculated O/E NLV ratio may be
helpful in predicting respiratory prognosis at birth in patients
with congenital lung lesions.
Poster #: SCI-014
Prenatal diagnosis of fetal skeletal dysplasias with 3DCT:
Dose evaluation using a custom-made phantom that matches
characteristics of pregnant women
Osamu Miyazaki, Chief1, [email protected]; Hideaki
Sawai, Dr.3, Takahiro Yamada, Dr.5, Jun Murotsuki, Dr.4,
Tetsuya Horiuchi1, Gen Nishimura, Dr.2; 1Dept. of Radiology,
National Center for Child Health and Development, Setagaya-
ku, Tokyo, Japan, 2Center for Intractable Disease, Saitama
Medical University Hospital., Omiya, Saitama, Japan, 3Department of Genetics, Hyogo Medical University,
Nishinomiya, Hyogo, Japan, 4Department of Maternal and Fetal
Medicine, Miyagi Children’s Hospital, Sendai, Miyagi,
Japan, 5Clinical Genetics Unit, Kyoto University Hospital,
Sakyoku, Kyoto, Japan
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Fetal CT has almost the same utility
as a postnatal skeletal survey. Despite this benefit, the
associated radiation exposure is disadvantageous and radiation
dose reduction is mandatory. It is however impossible to
measure the actual radiation dose to the fetus directly. Several
previous reports have described the CT dose index (CTDI)
volume and dose length product (DLP) as representing an
imagined fetal dose. The actual fetal radiation dose needs to be
confirmed using a phantom that practically corresponds to a
pregnant woman.
Methods & Materials: We created a custom-made phantom
that corresponds to a pregnant woman, using acrylic resin
(Polymethyl methacrylate: PMMA; 340 (Width) x 260 (Height)
x 300 (Length)). It could contained three artificial fetal
skeletons with different densities of calcium fluoride (300 HU:
1.90 mol/L, 500 HU: 3.63 mol/L, 700 HU: 5.37 mol/L). Dose
measurements were obtained using four CT scanners (GE,
TOSHIBA, SIEMENS, PHILIPS) at three different institutions
with the same scan parameters (CTDIvol: 3.0 mGy; tube
voltage: 80, 100, 120 kV) at four measurement points (distance
from skin surface: 4 cm, 7 cm, 10 cm, and center). We
compared the radiation dose for each tube voltage, at the
different measurement points. The differences in dose between
CTDIvol and measured data were assessed.
Results: The mean measured dose was 2.3 mGy at the center,
and 3.73 mGy, 4 cm from the skin surface, across all vendors
and tube voltages, corresponding to doses between 76% and
124% of the displayed CTDIvol (3 mGy). The maximum
deviation was 1.58 fold (at 120 kV, distance from skin surface:
4 cm). Doses in the peripheral part of the pelvis showed 1.5–1.8
fold greater exposure in comparison with the central position.
Doses increased in proportion to tube voltage settings and mean
doses at 120 kV were 1.03–1.18 fold greater than at 80 kV.
There were discrepancies in the measured dose among four CT
scanners that ranged from 61 to 120% (around the mean of 120
kV).
Conclusions: Fetuses undergoing CT for suspected skeletal
dysplasia may be exposed to approximately 0.8–1.2 times the
displayed CTDIvol on the CT console. We suggest that the
CTDIvol roughly represents fetal dose. There is however
heterogeneity and the wide range of fetal doses depends on the
position of the fetus, the selection of tube voltage, and CT units.
As pediatric radiologists, we should be aware of these
characteristics so that we can prevent excess radiation.
Poster #: SCI-015
Does Early Cerebral Blood Flow in Asphyxiated Neonates
Indicate Degree of Neural Injury?
Ann Hill1, [email protected]; Leslie E. Hirsig, MD3, Milad
Yazdani, M.D.3, Heather Collins, Ph.D.4, Dorothea Jenkins,
M.D.2; 1Medical University of South Carolina - College of
Medicine, Charleston, SC, 2Medical University of South
Carolina - Department of Pediatrics, Charleston, SC, 3Medical
University of South Carolina - Department of Radiology,
Charleston, SC, 4Medical University of South Carolina -
Department of Psychiatry & Behavioral Sciences, Charleston,
SC
Disclosures: Leslie Hirsig, MD: Other: SealCath. All other
authors have disclosed no financial interests, arrangements or
affiliations in the context of this activity.
Purpose or Case Report: MRS is the best prognostic indicator
for hypoxic-ischemic encephalopathy (HIE) but is difficult to
obtain early after injury. We investigated whether cerebral
blood flow measures of resistive indices (RI) and time average
maximum velocities (TAMx) shortly after birth would relate to
later degree of neural injury by MRI in hypothermic HIE
newborns. We predicted that abnormally high/low blood flow
would be associated with poor outcomes.
Methods & Materials: We retrospectively investigated 81
infants born between 2012 and 2018, ≥34 weeks gestation,
treated with hypothermia, who received a transcranial Doppler
ultrasound within 24 hours after birth, and MRI at 3-10 days.
Cerebral blood flow measures (RI, TAMx) in anterior cerebral
(ACA), middle cerebral (MCA) and basilar (BA) arteries were
correlated with MRS ratios of neuronal health (N-
acetylaspartate, NAA) in the basal ganglia (BG) and frontal
white matter (WM). As both high and low RI and TAMx are
abnormal, we divided our data into quartiles (Q) to find linear
correlations between blood flow and NAA.
Results: As resistance in MCA increased above normal (Q3),
NAA ratios in WM decreased (r2 = -0.574, p=0.02), reflecting a
decrease in neuronal integrity. Also, as blood flow velocity in
BA (Q4) increased above normal, NAA ratios decreased in BG
(r2 = -0.550, p =0.012). Conversely, as velocity in the BA
approached normal (Q2), NAA ratios increased in WM (r2 =
+0.618, p=0.011) indicating greater preservation of axons.
Conclusions: In this largest reported sample of cerebral blood
flow in hypothermic HIE neonates, increased resistive index in
the MCA and cerebral blood flow velocity in BA in the first 24h
after HIE birth are associated with more injury, and worse NAA
ratios. Transcranial doppler US can be performed at bedside
shortly after birth and might prove useful for earlier prognosis
in neonates with HIE.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S188
Poster #: SCI-016: Withdrawn
Poster #: SCI-017
Midgut Volvulus without Malrotation: Value of the
Superior mesenteric artery (SMA) cut-off sign - A report of
2 cases.
Mostafa Youssfi, MD, [email protected];
Deepa R. Biyyam, MD, Smita Bailey, MD; Phoenix Children’s
Hospital, Phoenix, AZ
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To share these uncommon but
important cases of Midgut Volvulus (MGV) without
malrotation.
Methods & Materials: - 15-day-old Male presented with
bilious emesis. An Ultrasound was perfomed.- 9-year-old
Female with History of cerebral palsy, Gastro-jejunostomy tube
fed. Presented with abdominal pain and hematemesis. A CT
scan was obtained.
Results: - The 15-day-old patient Ultrasound showed: SMA
Cut-off as well as Superior mesenteric vein (SMV) Cut-off. In
addition, congestion of the mesenteric venous vasculature and a
subtle swirling of the bowel around the SMA. The diagnosis of
Midgut Volvulus was made. No UGI examination was
performed. At Surgery, MGV without malrotation were found.-
The 9-year-old CT showed: SMA Cut-off as well as (SMV)
Cut-off. In addition, a subtle swirling/kinking of the bowel
around the SMA. The diagnosis of Midgut Volvulus was made.
No UGI examination was performed. At Surgery, MGV without
malrotation were found in addition to midgut infarction.
Conclusions: These 2 cases illustrate the fact that a typical
MGV can occur in the absence of malrotation. Although, no
UGI was performed, we speculate that UGI examination to the
ligament of Treitz may have been negative in these cases since
there was no malrotation at surgery.SMA cut-off sign was
important to make the diagnosis at Ultrasound and CT.
Poster #: SCI-018
The Value of MSCT in guiding staging and treatment of
hepatoblastoma in Children based on PRETEXT staging
system
Chen Guo, [email protected]; Yumin Zhong, Ying
Zhou, Li-Wei Hu, Master; Radiology, Shanghai Children’s
Medical Center affiliated with Shanghai Jiao Tong University
Medical School, Shanghai, China
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To apply the Couinaud’ system of
segmentation and PRETEXT staging system of the liver to the
tumor staging, combined with MSCT for evaluate the
effectiveness in pre or post therapy of hepatoblatoma.
Methods & Materials: We retrospectively reviewed the
outcomes of 67 cases that were diagnosed as hepatoblastoma in
our hospital between July of 2012 and September of 2017. The
patient ages ranged from 4 months and 5 years old (median age
3.2 years old). Couinaud’ system of segmentation of the liver
and PRETEXT staging system in MSCT were used to evaluate
hepatoblastoma. According to the staging system results and
imaging features, received the therapy relatively. We evaluate
the patient’s response to the therapy of these 67 cases. All cases
were confirmed by pathology, diagnostic accuracy was
calculated.
Results: Among the 67 cases: (1) The density of tumors were
heterogeneous and lower than hepatic tissues, 22/67 had
calcifications. (2) MSCT PRETEXT staging results: Stage I 7
cases, Stage II 31 cases, Stage III 26 cases, Stage IV 3 cases;
PRETEXT staging was used again according to the results of
operation: Stage I 7 cases, Stage II 27 cases,Stage III 31 case,
Stage IV 2 cases, the accuracy was 73.1%(49/67). (3) Therapy
evaluation: According to the PRETEXT staging and CT
features, 7 cases of Stage I and 24/27 of Stage II were
underwent the operation directly; As 3/27 of Stage II had ascites
or portal vein tumor thrombus, with 31 cases of Stage III and 2
case of Stage IV, were underwent tumor biopsy. 31 cases who
underwent the operation directly, 7 cases were followed up and
had no recurrence, 24 cases were underwent chemotherapy and
had no recurrence too. 36 cases were received 2 durations of
chemotherapy, all 36 tumors were reduced in size, but the
PRETEXT staging had no change, then the tumors were
received resection.
Conclusions: PRETEXT staging system combined with MSCT
is valuable for evaluaton the hepatoblastoma and conduting the
timing of surgery and the chemotherapy protocols.
Poster #: SCI-019
Ultrasound has limited diagnostic utility in children with
acute lymphoblastic leukemia developing pancreatitis.
Rebecca Richardson, MD1, [email protected]; Cara Morin,
MD, PhD1, Charles Wheeler1, Seth Karol2, Sima Jeha2, Hiroto
Inaba2, Beth McCarville, MD1; 1Diagnostic Imagin, St. Jude
Children's Research Hospital, Memphis, TN, 2St. Jude
Children's Research Hospital, Memphis, TN
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Acute lymphoblastic leukemia (ALL)
is the most common childhood malignancy. Children with ALL
are at risk for developing acute pancreatitis (AP) during
treatment, most commonly related to asparaginase. According to
the American College of Radiology guidelines, ultrasound (US)
should be the first line imaging modality in the diagnosis of AP.
However, AP in children with ALL is thought to be due to
direct pancreatic injury rather than ductal obstruction, and thus
US may not be the optimal imaging modality for this diagnosis.
Methods & Materials: This retrospective study was approved
by the institutional review board. Protocol databases were
searched for ALL patients who were diagnosed with AP during
therapy, according to Common Terminology Criteria for
Adverse Events (CTAE) version 3. This list was cross-
referenced with the diagnostic imaging database to identify
patients who had undergone abdominal US or CT within 10
days of AP diagnosis. Chemotherapy dosing, amylase/lipase
levels, clinical symptoms, and dates of imaging studies were
recorded. All CT and US studies were overread by a radiology
trainee blinded to the original imaging report, for findings of AP
according to the CT Severity Index (CTSI) and the Revised
Atlanta Classification. Discrepancies in the diagnosis of AP
were adjudicated by a pediatric radiologist.
Results: 69 patients, ranging from 2-21 years, experienced 88
episodes of AP (between 2008-2018) and underwent 98 US and
44 CT exams. 72/88 (82%) events occurred within 30 days of
asparaginase administration. 69 events (69/88, 78%) were
diagnosed clinically by the presence of abdominal pain and
amylase/lipase levels greater than 3 times the upper limit of
normal. No imaging was obtained in 18 (20%) of events. The
pancreas was completely obscured in 12/98 (12%) of US exams
and was never visualized in entirety by US. The overall
sensitivity for the detection of AP was 47% by US. Although
obtained less frequently, CT detected AP in all but one case
(98% sensitivity). CTAE Grade 4 events had the highest CTSI
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S189
scores, highest percentage of necrotizing pancreatitis, and
highest US sensitivity (83%).
Conclusions: Most cases of AP in children being treated for
ALL can be diagnosed with clinical history and labs. When
imaging is used, US is much less sensitive in detecting AP than
CT, except in the most severe cases (CTAE Grade 4). Imaging
to diagnose AP in this patient population should be limited to
clinically equivocal cases.
Poster #: SCI-020
Feasibility of a scoring system to predict reducibility and
surgical outcomes of ileocolic intussusceptions in children.
Edward Richer, MD, [email protected]; Dhruv Patel,
MD, Kiery Braithwaite, MD, Sarah Milla, MD, Jonathan M.
Loewen, MD; Radiology, Emory University, Atlanta, GA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Determine if a simple scoring system
can accurately predict the reducibility of ileocolic
intussusceptions with therapeutic enema, and eventual surgical
outcomes in those patients failing reduction.
Methods & Materials: An IRB approved, retrospective study
was performed. In previous, unpublished research, the authors
identified several imaging findings associated with a
significantly decreased success rate of therapeutic enema,
including presence of bowel obstruction on plain film, trapped
fluid and poor blood flow on ultrasound, and location of the
leading edge of the intussusception at or beyond the splenic
flexure. A scoring system was devised assigning 1 point to each
of these findings. This scoring system was then retrospectively
applied to the cases of ileocolic intussusception at our institution
between September 2012 – August 2017 in which plain films
and ultrasounds were both available. The cases were then
stratified according to their scores, and correlated with enema
results and surgical outcomes. Complicated surgical cases were
defined as those that required more extensive surgery than a
standard laparoscopic reduction, such as conversion to open
laparotomy.
Results: 191 cases were reviewed. Following point assignment,
the following categories were generated: Category 0 (114
cases), Category 1 (35 cases), Category 2 (32 cases), Category 3
(8 cases), and Category 4 (2 cases). Category 0 had the highest
enema success rate (86%) and lowest rates of complicated
surgery (3%) and bowel resection (3%). Lower rates of enema
success, and higher rates of complicated surgery and bowel
resection, were seen in higher categories. In grouped analysis,
there was a statistically significant decrease in enema success
rate between Categories 0-1 and Categories 2-4 (83% vs 19%, p
< 0.0001), and increase in complicated surgeries (4% vs 40%, p
< 0.0001) and bowel resections (3% vs 29%, p < 0.0001).
Conclusions: A simple scoring system based on imaging
findings obtained in most cases of ileocolic intussusception can
predict reducibility by therapeutic enema, as well as surgical
outcomes in cases of failed reductions. This information can be
useful to radiologists, surgeons, and emergency physicians
when determining patient management, as some patients may be
better served by proceeding to surgery rather than enema.
Further research to validate the scoring system in a prospective
fashion is planned.
Poster #: SCI-021
The bottom line on air enemas: Does “door to catheter” time
affect outcomes?
Kiery Braithwaite, MD, [email protected]; Dhruv
Patel, MD, Jonathan M. Loewen, MD, Sarah Milla, MD,
Edward Richer, MD; Radiology, Emory University, Atlanta,
GA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Determine if the length of time
between diagnosis of an intussusception and therapeutic enema,
or reported length of symptoms, is associated with lower enema
success rates or higher rates of complicated surgery and bowel
resection.
Methods & Materials: An IRB approved, retrospective study
was performed. The radiology information system at our
institution was queried for the keyword “intussusception” in
fluoroscopic reports from September 2012 – August 2017. The
length of time (“time to catheter”) between diagnosis of
intussusception, defined as the end time stamp of the ultrasound
or CT on which it was first identified, and the start of
therapeutic enema, defined as the first time stamp on images
from the enema, was then calculated. In addition, the medical
record was reviewed for overall length of symptoms (LOS) as
documented in the emergency department note. Correlation with
enema results, and surgical outcomes in patients failing
reduction, was then performed. Complicated surgical cases were
defined as those that required more extensive surgery than a
standard laparoscopic reduction, such as conversion to open
laparotomy.
Results: 209 cases were reviewed. There were 148 successful
enemas and 61 failures. No significant difference was found in
mean overall LOS between the 2 groups (1.44 days vs 1.58
days, p = 0.44) or in mean “time to catheter” (1 hour 53 minutes
vs 1 hour 54 minutes, p = 0.3). Using grouped analysis, in
patients with “time to catheter” of 0 – 4 hours versus those > 4
hours, no significant difference was identified in enema success
rates (71% vs 65%, p = 0.6), rates of complicated surgery (11%
vs 12%, p = 0.9), or rates of bowel resection (8% vs 12%, p =
0.56). Similarly, there was no significant difference among
groups with the shortest and longest LOS. In patients with LOS
0 – 1 days versus those > 2 days, enema success rates (73% vs
68%, p = 0.5), complicated surgery rates (9% vs 15%, p = 0.25),
and bowel resection rates (6% vs 13%, p = 0.14) were not
significantly different.
Conclusions: Air enemas for intussusception performed within
4 hours of diagnosis did not show a difference in rates of enema
success, complicated surgery, or bowel resection compared to
those performed greater than 4 hours after diagnosis.
Additionally, overall length of symptoms does not show a
difference in rates.
Poster #: SCI-022
Development of a 3D Ultrasound Bowel Phantom for
Trainee Education.
Rebecca A. Dennis, DO, [email protected]; E
lizabeth Silvestro, MSE, Lamont Hill, BS RT(R),
RDMS, Savvas Andronikou, MBBCh, FCRad, FRCR, PhD
(UCT), PhD (Wits), Sudha Anupindi, MD, Misun Hwang,
MD; Radiology, Children's Hospital of Philadelphia,
Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S190
Purpose or Case Report: To create a three dimensional (3D)
ultrasound (US) bowel phantom that simulates bowel
sonographic characteristics to aid in education for bowel
scanning techniques and for microbubble contrast utilization in
bowel.
Methods & Materials: A pliable 3D bowel US model
composed of silicone (Ecoflex® 00-35, Smooth-On) was made
containing a central lumen and a false lumen within the wall.
Multiple materials of various consistencies for simulating bowel
content including Play-Doh®(Hasbro), Play-Doh® in water,
Kinetic Sand™ (Spin Master), Kinetic Sand™ in water, Flarp
Putty® (Ja-Ru), polyvinyl acetate in water (Elmer’s® glue),
support material in water (Support 705®, Connex 500) and
Metamucil® in water were tied-off into nitrile gloves
separately. These were placed individually into the central
lumen of the synthetic bowel in a tub of water and a
sonographer with 17 years experience scanned the bowel using
a Philips EpiQ-7G to evaluate the sonographic characteristics.
Microbubbles (Lumason®, Bracco Diagnostics Inc) were then
injected into the false lumen and rescanned. A numerical
grading system was developed ranging from 4 to 12 to
determine the optimal material. The criteria assessed on US
included: visualization and imaging quality of the bowel wall(s),
± sonographic artifact and presence of echogenicity on B-mode
and signal intensity on contrast mode. The luminal material with
the highest score was deemed the optimal material.
Results: Materials ranged from a score of 6 to 12. The Play-
Doh®, support material and Elmer’s® glue each had the lowest
scores of 6 due to poor image quality, extensive artifact and
poor visualization of the bowel walls and Lumason® on
contrast mode. The Kinetic Sand™ had a score of 7 and was
better at visualizing the lateral bowel wall. The Metamucil® and
Flarp Putty® had scores of 8 and 9 respectively, with complete
visualization of the bowel wall and little artifact but both
materials had increased echogenicity on B-mode. Play-Doh® in
water and Kinetic Sand™ in water had the highest scores, 12
and 11 respectively. These materials demonstrated no artifact
from luminal content with optimal image quality of the bowel
wall. Yet, the Play-Doh® in water scored the highest due to best
Lumason® visualization in the bowel wall.
Conclusions: The preliminary data shows Play-Doh® dissolved
in water results in optimal sonographic characteristics for use in
a 3D US bowel phantom. Such a phantom model will serve as a
valuable training tool for grayscale and contrast enhanced bowel
US evaluation.
Poster #: SCI-023
Incidence and Findings of Genitourinary Involvement in
Pediatric Patients with Klippel-Trenaunay Syndrome
Nimai Patel1, [email protected]; Hubert Swana2, Craig
Johnson3; 1UCF College of Medicine, Orlando, FL, 2Arnold
Palmer Hospital for Children, Orlando, FL, 3Nemours
Children's Hospital, Orlando, FL
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To assess the incidence, scope,
clinical findings and imaging characteristics of GU pathology
due to underlying KTS in pediatric patients with the goal of
improved diagnosis and outcomes for children with this
potentially fatal disorder.
Methods & Materials: Using a retrospective data analysis
design, the charts and imaging studies of 58 patients with
confirmed diagnosis of KTS within a single tertiary care
pediatric health care system were studied for insight into the
degree of GU involvement in pediatric patients.
Results: 17% of patients (10) were noted to have GU findings,
with 5% (3) having extensive GU involvement (defined as
greater than 1 finding). The overall scope of GU involvement
was diverse and varied with more than 9 different findings
identified spanning 6 unique organs. Kidney, bladder and
scrotum had the most common findings. Hematuria was the
most common presenting symptom in 30% (3/10). Findings
included those discussed in the literature along with previously
unreported lymphatic findings. The importance of early
recognition of GU involvement due to KTS was confirmed as
the average age of GU complication was 7.6 years, less than 3
years after the average age of KTS diagnosis in this patient
population.
Conclusions: Significant GU complications due to KTS can
occur in the pediatric population with pathologies manifesting at
an early age and with delayed recognition. Early clinical and
imaging characterization of these conditions is important for
expectant management and early intervention strategies, thereby
playing a central role in improving patient education, patient
outcomes and reducing costs, morbidity and mortality.
Poster #: SCI-024
Post-mortem imaging assessment of endotracheal tube,
nasogastric tube and intraosseous trocar placement in
pediatric patients in the Emergency setting
Laura A. Fitzpatrick2, [email protected]; Dominic
Allain1, Pierre Schmit1; 1Department of Diagnostic Imaging ,
IWK Health Centre, Halifax, Nova Scotia, Canada, 2Dalhousie
University Department of Radiology, Halifax, Nova Scotia,
Canada
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Accurate placement of lines and
tubes is essential in pre-hospital emergent care of pediatric
patients, to ensure that lifesaving measuring can be initiated in
an effective and timely manner. Malpositioned pediatric tubes
can lead to failed resuscitation efforts. The purpose of this study
is to determine the prevalence of misplaced endotracheal tubes
(ETT), nasogastric tubes (NGT) and intraosseous trocars (IOT)
in the pediatric acute care setting using post-mortem imaging.
Methods & Materials: The post-mortem imaging for 87
patients under the purview of the Medical Examiner Office
performed between June 2007-May 2017 was retrospectively
reviewed by a Pediatric Radiologist as part of a quality review
in conjunction with the Nova Scotia Medical Examiner Service
and Emergency Health Services (EHS). Of these 87 patients, 27
patients were excluded as no tubes were placed. For the
remaining patients (N=61), ETT, NGT and IOT placement was
assessed using a combination of radiographs and multiplanar
CT, and characterized as “satisfactory position” or
“malpositioned”. For the malpostioned devices, the exact
location was also documented.
Results: Of the 45 patients with an ETT, the tube was in
satisfactory position in 9 (20%) patients and malpositioned in 36
(80%) patients. Of the malpositioned tubes, 5 were at the carina,
20 in the right main bronchus, 9 in the esophagus and 5 in other
locations (at T2, T4, nasopharynx, etc.). The NGT was in
satisfactory position in 13 (76%) patients and malpositioned in 4
(24%) patients, with tubes in the pharynx (two cases) and distal
esophagus (2 cases). Of the 58 IOTs inserted, 15 (26%) were in
satisfactory position and 43 (74%) were malpositioned,
including 10 that had been completely removed but with CT
evidence of prior incorrect positioning, 8 were through and
through bone and 6 in the superficial soft tissues.
Conclusions: Malpositioning of the ETT, NGT and IOTs in this
study is likely multifactorial. Tube placement is less common in
the pediatric emergency setting compared to adult medicine,
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S191
possibly resulting in decreased experience and comfort level
among pediatric EHS teams. There may be a role for further
specialized training, with more frequent recertification. Use of a
laryngeal airway mask could also be considered as an
alternative to ETT in pediatric patients with difficult airways.
The results of study will help to inform future training of
pediatric EHS teams at our institution, with ongoing review of
post-mortem imaging as a means of quality assurance.
Poster #: SCI-025
Optimizing Imaging Clinical Decision Support: Perspectives
of Pediatric Emergency Department Physicians
James Hogan, MD1, [email protected]; Rosemary Frasso,
Ph.D.2, Tigist Hailu, MPH1, Alyssa Tate, B.A.2, Robert Martin2,
Raymond Sze1; 1Children's Hospital of Philadelphia,
Philadelphia, PA, 2Thomas Jefferson University, Philadelphia,
PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To explore the imaging clinical
decision support (ICDS) needs of pediatric emergency
department physicians (PEDP’s) prior to the implementation of
imaging clinical decision support software (ICDSS).
Methods & Materials: Following institutional review board
approval, through semi-structured interviews, researchers
explored perspectives of 30 PEDP’s on how they seek and
obtain imaging consultation and the potential impact of ICDSS
on practice. Open-ended questions were designed to elicit a
range of responses rather than quantifiable data. The team
employed a directed content analysis approach and codes were
developed and explicitly defined through team evaluation.
Coding and analysis was facilitated by NVivo 12 Software. Two
research assistants independently coded all transcripts and
discrepancies were addressed through consensus (mean k =
0.99). Codes were arranged into thematic categories to inform
an explanatory model that illustrates the PEDP’s priorities and
needs related to the imaging decision process.
Results: Data analysis revealed three thematic categories: (1)
Common Influences on the Decision Process (these include
patient factors, PEDP’s experience, the specialist perspective,
and logistics), (2) Radiology Consultation Experience, (3)
PEDP Perspectives on ICDSS which includes perspectives on
how implementation of an ICDS system at our institution may
impact practice. PEDP’s described consultation as a valuable
component of ICDS but reported difficulty in coordinating an
imaging strategy with radiologists and other physician
consultants. PEDP’s described the exchange of ideas as
especially worthwhile for clinical scenarios that do not fit neatly
into ICDS pathways. Significant barriers to radiologist
consultation included: time, access to radiology attendings,
limited confidence in trainees, and not wanting to disrupt
radiologist workflow. PEDP’s expressed a belief that ICDSS
could potentially improve their workflow and augment effective
interaction with the radiology department.
Conclusions: PEDP’s predict that radiologist consultation will
continue to be an essential component of ICDS following the
implementation of ICDSS. These results present an opportunity
for radiologists to improve in-person radiologist consultation in
clinical and didactic settings. Additionally, these findings will
inform the development and implementation of an ICDSS
system that meets the needs of the PEDP's and ultimately
improves patient outcomes.
Poster #: SCI-026
Distinguishing between stable buckle fractures and other
distal radius fractures: improved accuracy utilizing a
measurement guideline
Lynne Ruess, [email protected]; Julie B.
Samora, MD, PhD; Nationwide Children's Hospital, Columbus,
OH
Disclosures: Julie B. Samora, MD, PhD: Consultant,
Honoraria: Globus. All other authors have disclosed no financial
interests, arrangements or affiliations in the context of this
activity.
Purpose or Case Report: To test radiographic diagnostic
accuracy for distinguishing between stable distal radius buckle
fractures (BF) from other distal radius fractures (DRF) after
introducing a measurement guideline.Background: Management
of pediatric forearm fractures has become fracture specific, as
treatment of the common stable BF is trending toward home
management with a removable wrist splint while other
potentially unstable, DRF require immobilization and
orthopaedic follow-up. Diagnostic accuracy between BF and
DRF is therefore imperative. We developed and suggested our
radiologists use a measurement guideline to aid diagnosis with
this general rule: an isolated distal radius fracture in a child > 7y
is not likely to be a BF if the fracture-to-physis distance is < 1
cm.
Methods & Materials: This study was part of a quality
improvement project between the Departments of Radiology
and Orthopaedic Surgery. Medical record search identified
children >3y with closed distal radius fractures diagnosed after
all of our 26 pediatric radiologists received explanation of the
measurement guideline. The radiology reports for the initial
forearm and/or wrist series were compared to the final diagnosis
(BF or DRF) as determined by consensus of 1 pediatric
radiologist and 1 pediatric hand surgeon. The fracture-to-physis
distance was measured for all fractures on the AP and LAT
views by 1 author.
Results: Results: Before introducing the measurement
guideline, radiologists received training to differentiate BF from
DRF, but diagnostic accuracy was only 54% in a patient group
with 148 BF and 55 DRF, and agreement was ‘slight’ (κ=0.120,
SE=0.058, n=203). In the first 6 months after introducing the
measurement guideline, there were 153 children >3y (range 4-
16y) with isolated distal radius fractures: 64 (42%) stable BF
and 89 (58%) potentially unstable DRF. Report diagnostic
accuracy = 84%. Agreement for the diagnosis in this patient
group was ‘moderate’ (κ=0.592, SE=0.066, n=153). Eleven
DRF were misdiagnosed as BF (sensitivity 83%). Thirteen BF
were misdiagnosed as DRF (specificity 86%). No patient > 7y
had a BF less than 1 cm from the physis. Only 1 false positive
BF misdiagnosis was made in an older patient with a fracture-
physis distance of < 1cm.
Conclusions: Conclusion: Diagnostic accuracy for
distinguishing stable buckle fractures versus potentially unstable
isolated distal radius fractures by our group of pediatric
radiologists improved after introduction of a measurement
guideline.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S192
Poster #: SCI-027
‘LogServer’: A Novel Customizable Tool to Automatically
Track MRI Scan Efficiency
Ramkumar Krishnamurthy, PhD1,
[email protected]; Roy
Wiggins2, Houchun Hu, PhD1, Rajesh Krishnamurthy1, Tobias
Block, Ph.D.2; 1Radiology, Nationwide Children's Hospital,
Columbus, OH, 2NYU-Medical Center, New York, NY
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: MRI scans are long, and scan
durations are unpredictable. Combined with challenges of inter-
departmental coordination, this leads to poorer operational
efficiency, increased need for sedation (especially in a pediatric
population), increased wait time, and overall poorer patient care.
There is a need for active, automatic tracking of scan log in a
MRI machine to 1) determine operational efficiency, 2)disease
specific scan information, 3) identifying patient specific scan
metrics.Currently, there exist no customizable open-source
solution that can automatically obtain information from MRI
scanners. The purpose of this study is to demonstrate
implementation of a novel, customizable QI tool that can
automatically extract scan log data from a MRI scanner in a
pediatric setting.
Methods & Materials: ‘LogServer’
(https://yarra.rocks/doc/server/yarralogserver/) was developed
for use in Siemens MRI machines. This uses the ‘Yarra’
framework – an open source framework for complex MRI
reconstructions. ‘LogServer’ monitors sequences, parses MRI
sequences into discrete exams, generates ‘EPIC-formatted’
patient names, monitors scanner health, and tags exams with
body region information. All extracted data were stored in
‘PostgreSQL’ - an open source database. ‘ReDASH’, an open
source dashboard, was used to create customizable dashboards.
In this study, for a clinical MRI scanner, we looked at 1) Daily
scanner efficiency, defined as ratio of total hours scanner
unused time to total hours (8am-7pm workday), and 2) Scan
efficiency, defined as time when scanner was running to total
time when the patient was on table.
Results: ‘LogServer’ was successfully able to automatically
extract scan logs from MRI machines on an hourly basis, extract
all relevant information, and visualize them in needed format
using a remote PHI secure web browser. Figure 1
(https://drive.google.com/open?id=1fvyrSjq96EcHaAv9GenX1
v4b070tFP3l) demonstrates the scanner schedule for any given
day. Figure 2
(https://drive.google.com/open?id=1O7fxAIhWrAeqFVr3qRW
5QyMGaN3F0mnX) shows the scan metrics for a selected
patient, including total scan time, idle time during a scan
session, as well time for adjustments in scanner. Our daily
scanner efficiency for a week was 64% while scan efficiency
was 76.3 ± 10%.
Conclusions: We demonstrated a robust customizable QI tool
that lets continuous automatic monitoring of MRI scanner. This
is a useful tool for hospital administrators, clinical managers,
clinical leaders in their informed decision making.
Poster #: SCI-028
Beyond the numbers: favorable perceptions of a scoreless
peer review pilot program.
A. Luana Stanescu, MD, [email protected];
Randolph K. Otto, MD, Ramesh Iyer, MD; Radiology, Seattle
Children's Hospital, Seattle, WA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Peer review is an essential
component of quality improvement in radiology departments.
Over the last years, several papers described a shift towards peer
learning, emphasizing that feedback in the form of comments
and peer learning conferences creates a more productive
environment for reviewing and understanding perceptual or
interpretive errors of peer radiologists, with improved
diagnostic performance as the objective.At our institution, we
instituted a three-month scoreless peer review pilot period.
Radiologists’ impressions regarding the current comment-
enhanced numerical system and the pilot scoreless, comments-
only period were collected through an online survey.
Methods & Materials: The survey containing 17 questions was
distributed twice to the radiologists in our group to evaluate and
compare their perceptions regarding the numerical scoring and
the scoreless peer review systems. A Likert-style rating scale of
1-5 was used for the survey, ranging from strongly disagree (1)
to strongly agree (5). The first survey, administered at the
inception of our pilot period, was applied towards the numerical
scoring system. The second survey, administered at the end of
the pilot period, targeted the scoreless peer review system.
Responses from both surveys were compared.
Results: 16 out of 20 radiologists in our group responded to
both surveys. Overall satisfaction was slightly higher (weighted
average of 3.64 versus 3.5) for the scoreless peer review
compared to the numerical scoring system. Our colleagues felt
more likely to underreport while reviewing a case with the
numerical system as compared to the scoreless one. Reported
negative emotional impact from discordances was slightly
higher with the scoring system. Radiologists felt more inclined
to provide a comment for educational purposes when agreeing
with the interpretation while using the scoreless system.
Comments were felt to be important in both systems.
Conclusions: A scoreless comments-only peer review system
shows promise in providing more educational opportunities than
a comment-enhanced numerical system, with less negative
emotional impact on participant radiologists. This benefit may
be even greater in practices in which radiologists are prone to
underscore their colleagues.
Poster #: SCI-029
Value of specialist interpretation of cross-sectional pediatric
imaging studies
Summit H. Shah, MD, MPH, [email protected];
Ramkumar Krishnamurthy, PhD, Sean Kelleher, Rajesh
Krishnamurthy; Radiology, Nationwide Children's Hospital,
Columbus, OH
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Two major insurance companies
have recently enacted policies requiring outpatient advanced
imaging at free-standing imaging facilities for adults.
Examining the potential clinical and economic implications of
non-subspecialized interpretations in children is important. We
evaluated the rate of major discrepancies and changes in
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S193
management arising from second interpretations by a dedicated
pediatric facility.
Methods & Materials: A retrospective and prospective analysis
of CTs and MRs presenting for over-read by a pediatric
radiologist was performed. For the prospective review, a
standardized dictation template was implemented to track
disagreements. A board-certified radiologist identified cases
with major discrepancies as defined by those that were likely to
change surgical or medical management. A chart review was
performed to identify changes in clinical course and outcomes
based on the second interpretation.
Results: 1397 patients were referred to our pediatric hospital for
second interpretation following an outside facility interpretation.
3.6% of all patients (18/574 patients from retrospective review
and 32/823 patients from prospective analysis) had major
discrepancies between the outside report and the pediatric
subspecialty interpretation. Of all major discrepancies, 31 were
body cases (chest, abdomen, or pelvis), 13 were neuroradiology
cases (head or neck), and 6 were musculoskeletal cases (spine or
joint). Second interpretations changed surgical management for
14 patients, with 4 patients receiving a necessary surgery and 10
patients avoiding an unnecessary surgery. Medical management
changed for 36 patients. Eleven of the cases with major
discrepancies involved an incorrect diagnosis related to
appendicitis. Examples of other serious missed findings
included secondary reads that lead to diagnoses of
meningoencephalitis, Crohn’s disease, herpes encephalitis,
intracranial hemorrhage, pulmonary embolism, and ovarian
teratoma.
Conclusions: Pediatric subspecialty interpretations altered the
surgical or medical management in 3.6% of referrals, which
compares with a 0.4% rate of level 3 and 4 errors from the ACR
RADPEER database. This supports the case for performing and
interpreting these studies at a facility with dedicated pediatric
radiologists. Since changes in reimbursement related to
hospital-based cross-sectional imaging are driven by costs, the
potential long-term adverse economic impact of non-
subspecialized interpretations suggested by our study needs to
be carefully considered.
Poster #: SCI-030
Clinical quality and cost effectiveness of a pediatric MRI
simulator program
Summit H. Shah, MD, MPH, [email protected]; Phillip
McGonagill, BA, Lean Six Sigma Black Belt, Houchon
Hu, Akila Sankaran, Rajesh Krishnamurthy, Ramkumar
Krishnamurthy, PhD; Radiology, Nationwide Children's
Hospital, Columbus, OH
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: The likelihood of sedation for an
MRI exam in a patient under 8 years is high. Disadvantages of
sedation usage include direct complications, suspected long-
term effects, and higher costs. Sedation reduction techniques
include the use of an MRI simulator, accelerated MRI scans,
abbreviated protocols, and swaddle and sleep techniques. We
evaluated the clinical image quality and cost effectiveness
associated with an MRI simulator training program.
Methods & Materials: An MRI simulator program was
created, and all patients going through the program from Aug
2014 and Oct 2018 were analyzed. To assess clinical image
quality, 20 brain MRIs of age-matched patients were randomly
selected including 10 patients who avoided sedation after the
simulator program and 10 patients who received sedation for a
brain MRI. A blinded pediatric radiologist scored the same 3
sequences on each study on a 4-point quality scale
(1=significant limitations for clinical use, 2=moderate
limitations, 3=minimal limitations, 4=no limitations). To assess
cost effectiveness, success rate of avoiding sedation after
simulation was calculated along with average differential cost to
payer for a sedated MRI vs. a non-sedated MRI after MRI
simulator training.
Results: 592 patients (mean age: 7.9 ± 3.0 years) were enrolled
in the MRI simulator program over 4 years with the majority
scheduled for a brain MRI (71%). The mean image quality score
for sedated brain MRIs was 3.50 ± 0.51, and the mean quality
score for non-sedated brain MRIs after successfully completing
the MRI simulator program was 3.37 ± 0.49. All examined
sequences demonstrated minimal to no limitations for clinical
use. No sequence was found to have moderate or significant
limitations for clinical use in either group. The success rate of
children avoiding sedation after MRI simulation was 87%. The
average differential cost to payer was $963 higher for a sedated
MRI than an MRI that avoided sedation after MRI simulator
training. Factoring in the success rate, the total payer cost
savings over 4 years was estimated to be $495,984 for our
simulator program.
Conclusions: In addition to reducing sedation rates, our study
validates the clinical image quality of non-sedated pediatric
MRIs obtained after successful simulator training and
demonstrates the cost effectiveness of a simulator program over
4 years. The clinical quality and large payer cost savings should
be considered when evaluating future reimbursements and
investments for MRI simulator programs in pediatric patients.
Poster #: SCI-031
Distinguishing Button Batteries from Other Foreign Bodies:
Specialized Skill or Flip of a Coin?
Jennifer L. Nicholas, MD, MHA,
[email protected]; Michael Marrocco, MD, Peter
Shelton, MD, Amy Killeen, MD, Steven Don, MD;
Mallinckrodt Institute of Radiology, Saint Louis, MO
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: A button battery lodged in the
esophagus is a medical emergency. This study evaluated how
accurately button batteries can be distinguished from other
ingested foreign bodies on radiographs and how this influences
clinical management.
Methods & Materials: 71 cases of ingested foreign bodies
were compiled, anonymized, and randomized. 49 were clinical
cases and 22 were created using a chest phantom (italics).
Fifteen cases were button batteries (6); 2 were hearing aid
batteries (1); 20 were a single penny (1), 3 were 2 pennies
stacked on each other, 4 were a nickel (1), 1 was a dime (1), 2
were a single quarter (1), and 2 were a quarter with at least one
other coin. Remaining cases were identified only as "coin",
were foreign coins, or other round objects.12 clinicians ranging
from PGY-2 to 30 years of experience participated in the study:
5 radiology residents, 2 radiology fellows, 2 radiology
attendings, 1 ED fellow, 1 ED attending, and 1 pediatric
attending. The cases were presented in Synapse PACS. The
participants indicated the likelihood the object was a button
battery using a Likert scale: 5 (definitely), 4 (probably), 3 (equal
likelihood), 2 (probably NOT), 1 (definitely NOT); to decide
how urgently the object needed to be removed (4=within 2 hrs
regardless of NPO status, 3=within 24 hrs, 2=electively, 1=does
not need to be removed); and were asked how comfortable they
were identifying button batteries on radiographs before and after
viewing the cases and after reviewing the answers.
Results: The average score for cases containing a button battery
was 4.62 (Rads 4.67; ED 4.34; Peds 4.06). The average score
for a single penny was 2.09 (Rads 1.87; ED 2.63; Peds 2.90).
The average level of urgency for removal of button batteries
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S194
was 3.89 (Rads 3.86; ED 4.00; Peds 4.00). The average level of
urgency for removal of a single penny was 2.93 (Rads 2.89; ED
3.50; Peds 3.27). The average degree of confidence before the
cases were reviewed was 64%, 70% after viewing, and 85%
after reviewing the answers.
Conclusions: Button batteries are readily distinguishable from
other foreign bodies on radiographs, which helps to guide
appropriate clinical management. Radiologists more accurately
distinguish between button batteries and coins and clinicians are
more likely to recommend emergent removal. This exercise
increased the participants' levels of confidence in identifying
button batteries on radiographs and could serve as a valuable
teaching tool.
Poster #: SCI-032
Clinical Usefulness of MR Lymphangiography in Pediatric
Patients
Seunghyun Lee, [email protected]; Saebeom
Hur, Young Hun Choi, Yeon Jin Cho, Jung-Eun Cheon, Woo
Sun Kim, In-One Kim; Radiology, Seoul National University
Hospital, Seoul, Korea (the Republic of)
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: The recent advances of the lymphatic
intervention, has prompted progress in imaging of the lymphatic
system. We would describe the clinical usefulness of the
dynamic contrast-enhanced (DCE) magnetic resonance (MR)
lymphangiography for imaging of the lymphatic system in
pediatric patients.
Methods & Materials: A retrospectively evaluation of
experience with DCE MR lymphangiography in four patients
(Mean age 11.3 ± 5.5 years) was performed. The access needle
was placed in the central part of both inguinal lymph nodes
(LNs) under ultrasound guidance. CT contrast agent was
injected into the LNs to confirm proper access under
fluoroscopic guidance. After moving patients into the MR
imaging room, MR contrast material was injected into the
inguinal LNs for DCE MR imaging by using T1-weighted 3D
gradient sequence with VIBE in the coronal plane that can be
acquired in 15-30 seconds was repeated every other minute to
study lymphatic transit into the cisterna chyli and thoracic duct
and ultimately into the confluence of the left internal jugular
vein and subclavian vein.
Results: Three patients were suspected to have protein-losing
enteropathy. Two of these patients had a history of Fontan
operation and liver transplantation, and one patient had no
underlying disease. Another one patient was suspected to have
chylothorax with unknown cause. The DCE MR
lymphangiographic findings confirmed the presence of
relatively normal thoracic duct in one patient, and abnormal
thoracic duct dilatation in three patients. We could identify the
retroperitoneal lymph system through DCE MR, though it did
not provide evidence of the direct lymphatic leak to the
retroperitoneal space associated with the symptoms in all
patients. However, DCE MR showed an abnormal lymphatic
leakage draining into the pleural space in one patient having
chylothorax. The DCE MR lymphangiographic finding led to a
help in management in all patients, continuation of conservative
treatment in two patients, and intervention treatment in two
patients. Image quality for visualizing the lymphatic system was
considered good by both radiologists in all cases. There were no
known adverse effects related to the DCE MR
lymphangiography.
Conclusions: DCE MR lymphangiography is a recently
developed technology, and its clinical application is feasible in
pediatric patients. The application of DCE MR
lymphangiography would significantly increase in pediatric
patients as the lymph-based understanding of many diseases
increases.
Poster #: SCI-033
Evaluation of the Experience with Implanted Venous Port-
a-Caths in Children with Medical Complexity and
Neurologic Impairment
Paymun Pezeshkpour, B. Sc.,
[email protected]; Nicholas
Armstrong, Sanjay Mahant, Prakash Muthusami, Joao
Amaral, Dimitri Parra, Michael Temple, Bairbre
Connolly; Hospital for Sick Children, Toronto, Ontario, Canada
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To analyze the use of implanted port-
a-caths in Children with Medical Complexity (CMC),
neurological impairment and difficult venous access.
Methods & Materials: REB approved retrospective single
centre observational study of port-a-caths placed by
Interventional Radiology (IR), in CMC with neurological
impairment, to meet their general vascular access needs. Details
of peripheral intravenous (PIV) attempts, PIV successful starts,
PIV complications, alternative devices, port-a-cath insertions,
dwell times, times accessed, and port-a-cath-related
complications were analyzed. Information for the year pre-port-
a-cath was compared to the year post-port-a-cath in 21 patients
(10M; 11F). The Wilcoxon signed ranks test were performed by
SPSS.
Results: 21 patients underwent 26 port-a-cath insertions
(median age 3 years; median weight 12.7 kg). The median port-
a-cath dwell time was 26.5 months, total number of port-a-cath
dwell days was 31,632 and total number of days accessed was
1,066 (median 21/pt). There was a significant reduction
(p<0.05) in number of PIV attempts, PIV starts, needle pokes,
ED visits and admissions in year the post-port-a-cath compared
to pre-port-a-cath. There was no severe adverse events, 6
moderate and 18 mild adverse events. Limitations of the study
include its retrospective design, lack of scores for difficult IV
access or scales for IV infiltration and extravasation.
Conclusions: Port-a-cath placement in CMC significantly
reduced the number of PIV attempts, needle pokes and
admission requirements with no major added complications.
These results provide useful information for parents and health
care providers considering port-a-cath placement in this
population.
Poster #: SCI-034
Embolization of the Lateral Marginal Vein in Klippel-
Trenaunay Patients: Early Experience with ClariveinTM
Daniel Ashton,[email protected]; Texas Children's
Hospital, Houston, TX
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: The lateral marginal vein, a
persistent embryonic vein found in Klippel-Trenaunay (KT)
patients, can be a major cause of morbidity such as venous
hypertension and venous thromboembolism. Our purpose is to
report our experience embolizing the lateral marginal vein using
the ClariveinTM device, a pharmacomechanical embolization
system.
Methods & Materials: Retrospective review of PACS and
EMR for KT patients undergoing treatment of their lateral
marginal vein using the ClariveinTM device. Patient
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S195
demographics, technical details of the procedure, and follow up
imaging was collected.
Results: Four KT patients underwent four procedures to
embolize the lateral marginal venous system. Technical success
was 100% and there were no complications related to the
embolization. Two of the four patients underwent additional
therapies at the same time including sclerotherapy for venous
and lymphatic malformations. Three of the four patients had
ultrasound follow up that demonstrated complete occlusion of
the treated venous segment. One patient had partial
recanalization on further follow up one month after the
procedure and underwent laser ablation which was also only
partially successful.
Conclusions: Embolization of the lateral marginal venous
system with the ClariveinTM device may be a good option for
effective treatment.
Poster #: SCI-035
Fabrication of a custom pediatric phantom for pediatric
interventional radiology endovascular simulation and
training. Technical aspects.
Elizabeth Silvestro, MSE, [email protected]; Sphoorti
Shellikeri, Master's in Biomedical Engineering, Sean Trahan,
BSE, Raymond Sze, Anne Marie Cahill; Radiology, Children's
Hospital of Philadelphia, Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: 3D printing technology presents a
unique opportunity for the creation of custom phantoms for
training and simulation for pediatric interventional procedures
that are complex and/or uncommonly performed. The purpose
of this study was to describe the elements of designing a 3D
phantom for simulation of pediatric abdominal intra -vascular
procedures.
Methods & Materials: In order to create a phantom design
considerations such as the consistency of the "soft tissues",
vascular system, creation of flow simulation and visibility of the
vascular components using fluoroscopy, needed to be
considered.
Results: Silicone was the chosen material poured into 3D
printed molds with break-away and dissolvable internal cavities
to create the anatomic vein and atrial system. The phantom
design was also divided into three main regions of interest:
chest, neck, and thigh. Rubber tube connections between the
regions and pumps allowed for circulatory flow.The design
process of the phantom consisted of incorporating several 15-
year-old patient CTA exams to create the atrial and venous
pathways. The pathways were then aligned with regions (chest,
neck, thigh) segmented from CT exams
in MaterialiseMimics and3-Matic. Connection ports between
regions were added. Access points covered with a replaceable
“skin patch” were added to the neck and thigh regions for
reusability. The mold and breakaway cavities were 3D printed
on a StratasysFortus450mcin ABS plastic. Smooth-On
Ecoflex30was selected for molding to simulate the body
and DragonSkin10for the skin patch based off the
ShoreValue.Phantom feasibilityfor fluoroscopic visibility,
contrast visibility, angiography, venography and device
placement and removal was assessed and was successful in this
prototype.
Conclusions: Phantom creation for pediatric interventional
radiology simulation and training is an exciting prospect in
pediatric IR for complex and/uncommonly performed
procedures both for attending staff skill maintenance and initial
training for fellows and residents. Going forward subsections of
this phantom will be removable for repeat procedures such as
stent placement.
Poster #: SCI-036
Percutaneous Treatment of Aneurysmal Bone Cysts in the
Pediatric and Adolescent Population
Alexander M. Dabrowiecki, MD1, [email protected];
Anne Gill, MD2, C. Matthew Hawkins, MD2; 1Emory
University School of Medicine, Atlanta, GA, 2Children's
Healthcare of Atlanta, Atlanta, GA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Aneurysmal bone cysts (ABCs) are
expansile lytic lesions and can cause significant disability and
pain most commonly seen in patients 10-30 years old. This
study evaluates the technical feasibility, safety, and efficacy of
percutaneous management of ABCs in pediatric and adolescent
patients.
Methods & Materials: In this Institutional Review Board
approved retrospective study, 11 consecutive ABCs treated with
doxycycline sclerotherapy and/or percutaneous ablation from
December 2015 to October 2018 were evaluated.
Demographics, clinical presentation, procedural details, and
safety/efficacy outcomes were assessed.
Results: A total of 11 ABCs in 11 patients (average age = 13.4
yrs; range: 8-17) were treated with 22 total procedures (range:
1-4 treatments/patient). 7/11 (63.6%) ABCs presented with
recurrence following surgical resection. ABC location included
spine 3/11 (27.3%), pelvis 4/11 (36.4%), lower extremity 2/11
(18.1%), humerus 1/11 (9.1%), and rib 1/11 (9.1%).
Doxycycline sclerotherapy alone was used in 10 procedures in 4
(36.4%) patients, cryoablation alone was used in 7 procedures in
4 (36.4%) patients, and a combination of percutaneous ablation
and doxycycline was used in 5 procedures in 3 patients (27.3%).
All 22 (100%) procedures were technically successful.
Clinically, 10/11 (91%) showed clinical improvement including
cessation of pain and improved range of motion. Mean follow-
up time= 9 months (range: 1-20 months). On imaging, 9/10
(90%) ABCs decreased in size with increasing sclerosis on
follow-up imaging. 1/10 (10%) ABC did not respond to
percutaneous treatment and required repeat surgical resection.
One patient is awaiting imaging follow-up. 1/11 (9.1%) patient
experienced a major complication of left lower-extremity
paralysis, bowel incontinence, and fecal incontinence following
treatment of an L4 ABC that resolved. 1/11 (9.1%) patient
experienced a minor complication of transient numbness of the
lateral thigh.
Conclusions: Percutaneous treatment of ABCs is a safe and
efficacious treatment option in the pediatric and adolescent
population.
Poster #: SCI-037
Posteriorly Tunneled Central Lines in Children: Does it
decrease rates of dislodgement?
Michael Acord, MD1, [email protected]; Carl A.
Termine2, Anne Marie Cahill1, Fernando Escobar, MD1; 1Radiology, Children's Hospital of Philadelphia, Philadelphia,
PA, 2Monmouth Medical Center, Long Branch, NJ
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To assess the rate of dislodgement of
posteriorly tunneled central lines, over-the-shoulder, in children.
Methods & Materials: This was a single center, IRB-approved
retrospective study of all children with a posteriorly tunneled
central line placed in pediatric interventional radiology over a
12-year period. The following parameters were reported;
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S196
indication for posterior line placement, type of catheter, number
of catheter days, rates and reasons for replacement, and
infections. Mechanical complications were also assessed, which
were defined as catheter fracture, occlusion, cuff exposure, or
tip migration. For each patient, time between dislodgement or
removal with a posterior line was compared to time to
dislodgement or removal of that patient’s most recently placed
anterior line.
Results: 17 patients (4 female, 13 male) underwent 68 posterior
line placements during the study period, most commonly for
total parenteral nutrition administration (58.8%). Median age at
posterior line placement was 12.5 months (IQR= 10.3-19.5).
Lines were most commonly single lumen (73.9%), silicone
(86.6%), and placed via the right IJ (76.7%). The most common
indication for posterior line placement was to avoid patient line
manipulation (76.4%). The total number of catheter days was
10,699. The median number of days between catheter
replacements was 80 (IQR= 18-150); however, only 9 (13.2%)
lines were replaced due to pulling by the patient. The most
common reason for replacement was for mechanical
complications (47.1% or 2.99 per 1000 catheter days), which
included 11 fractured catheters and 11 unintentional cuff
exposures. There were 20 catheters (1.86 per 1000 catheter days
or 29.0%) that were removed for infection. When compared to
the most recently placed anterior line, posteriorly lines remained
in place for significantly longer duration (mean 66.2 ± 15.5
(SEM) days vs 31.3 ± 5.6 days, p=0.04).
Conclusions: Posterior tunneled central line placement is a
potential longer-lasting option in children at risk for intentional
catheter dislodgement but is associated with a high mechanical
complication rate.
Poster #: SCI-038
Sharp recanalization provides restoration of patency across
stenosed hepatic venous circulation in pediatric patients.
Thomas Shum, PhD, [email protected]; Heather Cleveland,
BSRS, PA-S, Alex Chau, MD, Daniel Ashton, Alberto j.
Hernandez; Texas Children's Hospital, Houston, TX
Disclosures: Thomas Shum, PhD: Financial Interest: Translate
Bio - Intellectual property rights for a licensed patent: Patent co-
author. All other authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Stenosis of the inferior vena cava or
the hepatic veins is an underlying cause for hepatic compromise
in liver transplant patients and in patients with inflammatory
diseases of the liver, leading to considerable morbidity. CT-
guided or ultrasound-guided minimally invasive vessel
recanalization procedures can reverse liver failure in these
patients by restoring vessel patency. However, it can be difficult
to employ these techniques using traditional guidewire tips
against fibrotic obstructions associated with vessels that have
undergone repeated stenosis. Sharp recanalization offers an
alternative strategy to gain access through these obstacles by
utilizing needles or the sharp end of the guidewire tip to
penetrate the vessel obstruction. This technique has been well-
described and employed successfully in adult patients, but has
not yet been reported in the pediatric setting.
Results: Here, we present 3 cases of image-guided hepatic vein
sharp recanalization in pediatric patients, one of whom required
stent placement for recurrent venous stenotic obstructions of the
inferior vena cava and hepatic veins. We were able to restore
hepatic vein patency in all three patients with no acute or long-
term complications. Two of the patients had undergone previous
liver transplants, and in following the durability of the venous
recanalization in these patients, we observed long-term
extension of liver graft life to the extent of at least 18 months
and 38 months, respectively.
Conclusions: To the best of our knowledge, we present the first
application of sharp recanalization in pediatric patients, and
demonstrate evidence that it can be used safely and effectively
to restore IVC and HV patency and prolong liver function in
this patient population.
Poster #: SCI-039
Multimodality image fusion for guiding pediatric
interventional radiology procedures: Preliminary
evaluation
Karun Sharma1, [email protected];
Bhupender Yadav1, Ranjith Vellody1, William Plishker2, Raj
Shekhar1; 1Children's National Health System, Washington,
DC, 2IGI Technologies, College Park, MD
Disclosures: William Plishker: Ownership/partnership
/principal & Officer, Director or other fiduciary role: IGI
Technologies; Raj Shekhar: Ownership/partnership/principal:
IGI Technologies. All other authors have disclosed no financial
interests, arrangements or affiliations in the context of this
activity.
Purpose or Case Report: Percutaneous CT-guided biopsy and
ablation are established techniques to diagnose and treat solid
tumors. However, some tumors are not adequately visualized
with CT, even after IV contrast administration, because of
transient enhancement. Many of these “CT-occult” tumors are
optimally seen on preprocedural MRI or PET scans. To enable
targeting of such tumors, we developed software that fuses
MRI/PET images to intraprocedural CT in real time. The
software corrects for soft-tissue deformations which occur due
to differences in patient positioning or motion. The fusion
imaging is generated after each intraprocedural CT scan and
takes advantage of all available imaging data. We report
retrospective evaluation of this fusion method for pediatric
interventional radiology procedures.
Methods & Materials: The software was tested on four patients
with CT-occult tumors undergoing biopsy. Two patients had
bone lesions (Salmonella osteomyelitis and Ewing Sarcoma)
that were optimally visualized on preprocedural MRI and PET.
Two patients with neurofibromatosis had soft-tissue lesions with
regions that were suspicious for malignant transformation best
seen on preprocedural MRI and PET. During biopsy, CT images
were pushed from the scanner to the workstation and fused with
the corresponding MRI or PET. The time and accuracy of image
fusion were measured. Accuracy was measured as target
registration error (TRE) at anatomic landmarks identified by an
expert in individual images while blinded to the fusion images.
Results: Clinical experts reviewed the fusion images after the
procedures and judged them to be visually adequate and
accurate. The mean TRE of 4.1 mm supported this finding. The
TRE data further showed that the algorithm achieved subvoxel
registration accuracy (registration error < voxel size) of 0.85
voxels, averaged over all four cases. The mean time of image
data transfer from CT scanner to the fusion workstation was 2.0
s for volumetric and 0.4 s for fluoroscopic scans. The mean time
to perform image fusion was 35.7 s for volumetric scans and 7.0
s for fluoroscopic scans.
Conclusions: The image fusion software was fast and allowed
accurate visualization of MRI/PET visible tumors on the
intraprocedural CT images. When fully integrated in the IR
workflow, this tool has the potential to provide improve
targeting of CT-occult tumors and improve efficiency and
efficacy for CT-guided biopsy and ablation. A prospective
clinical trial is planned to quantify the anticipated clinical
benefits.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S197
Poster #: SCI-040
Imaging and Clinical Findings of Aneurysmal Bone Cysts
Post-Percutaneous Cryoablation
Jonathon Weber, MD, [email protected]; Jonathan
Samet, MD, Jared Green, MD, James Donaldson, MD, Shankar
Rajeswaran, MD; Radiology, Ann and Robert H. Lurie
Children's Hospital of Chicago, Chicago, IL
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Aneurysmal bone cysts are benign
expansile osseous lesions which may behave locally
aggressively, leading to growth plate destruction, angular
deformity, and pathologic fracture. Current treatments such as
curettage and bone graft reconstruction, sclerosis, and intra-
arterial embolization have high recurrence rates and morbidity.
Percutaneous cryoablation is a promising new treatment
modality. Three patients with ABCs underwent cryoablation at
our institution and follow-up MRIs over the span of a year were
obtained. This is the first study of its kind to elucidate the
imaging findings post-cryoablation of ABCs, which may help
the radiologist interpret response to treatment.
Methods & Materials: In this HIPAA compliant, IRB-
approved study, three children with ABCs were treated using
IcePearl percutaneous cryoablation needles (Galil Medical).
Patients included an 11-year girl with a clavicular lesion, a 16
year-old girl with a femoral lesion, and a 14-year old boy with a
femoral lesion. Clinical and imaging follow up with MRI
occurred at 3, 6, and 12 months.
Results: Common imaging findings after cryoablation include
resolution of fluid-fluid levels, decreased size of a T2-
hyperintense core, appearance of a sclerotic rim of bone, and a
cryoablation burn zone. All patients reported markedly
decreased pain and return to normal activity by 6 months post
treatment, including one patient able to play a full hockey game
at 3 months. No major complications were reported. No clinical
or imaging indicators were present to suggest recurrence.
Conclusions: ABCs are a difficult entity to treat with high
recurrence rates and morbidity with current treatment options.
After percutaneous cryoablation, ABCs may show common
imaging findings which may help radiologists monitor treatment
efficacy. All three patients treated at our institution showed
excellent clinical results. Percutaneous cryoablation is a
promising treatment modality for ABCs which in our series
confers exceptional benefit to patient symptomatology without
serious morbidity.
Poster #: SCI-041
Sonoelastography in the Evaluation of Cutaneous
Fibrosclerotic Conditions
Maria Manuela Perez Matta, MD,
[email protected]; Jennifer Zuccaro, Arun
Mohanta, Joel Fish, MD, FRCSC, Elena Pope, MD, Ronald
Laxer, MD, Andrea Doria, MD; Diagnostic Imaging, Hospital
for Sick Children, Hamilton, Ontario, Canada
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Acoustic radiation force imaging
(ARFI) is a type of quantitative sonoelastography (SE) that has
been used to determine tissue stiffness in many disorders
including liver fibrosis, breast cancer, thyroid nodules and more
recently, cutaneous scleroderma. However the use of this
technology for the assessment of skin lesions in the paediatric
population has not yet been investigated. The purpose of this
study is to test the feasibility of using ARFI SE to quantify the
stiffness of morphea or localized scleroderma (LS) and
hypertrophic burn scars (HTS), two skin conditions in which
there is excessive deposition of collagenous and non-
collagenous extracellular matrix causing fibrosis.
Methods & Materials: We employed conventional ultrasound
(US) and ARFI SE to characterize changes in the skin of pre-
assigned LS and HTS lesions and compared them to the normal
contralateral sites as controls. The inclusion criteria was clinical
diagnosis of the corresponding skin condition by a specialist.
For each participant, a “target lesion” was selected and marked
by the clinician as well as a section of contralateral matched
normal skin for US and ARFI measurements. The Wilcoxon
signed-rank test was used to compare scar and control sites.
Results: 26 patients from the outpatient Morphea (n = 13) and
Burn (n = 13) clinics at our tertiary pediatric hospital were
prospectively recruited (age range: 4 to 16; 12 females, 14
males). Lesions varied in location and severity. As expected LS
lesions and HTS were significantly stiffer than normal skin (E
means of 17.61 for LS and 41.11 kPa for HTS respectively,
versus 10.32 and 10.05 kPa for the normal controls).Skin
thickness of the LS lesions was 30.7% thinner than the
respective healthy skin, but the difference between means was
only significant for the dermal layer. HTS were significantly
thicker than the control sites (p < 0.05). Mean thickness values
for the scar and control sites were 4.06 mm and 1.43 mm
respectively. Variable changes in echogenicity and vascularity
were seen in both group of lesions.
Conclusions: This study demonstrated the feasibility of using
ARFI SE to discriminate between normal skin and fibrosclerotic
skin conditions (LS and HTS) by measuring skin stiffness. In
addition, the findings show that both these types of lesions are
significantly stiffer than normal skin. Future research should
focus on establishing reference data and determining the
technology’s ability to detect scar changes over time and
evaluate response to treatment.
Poster #: SCI-042
Pediatric Sacroiliac Joint Infection on MRI: Are There Age-
Specific Imaging Features?
Sara Cohen, MD, [email protected]; David M. Biko,
MD, Summer Kaplan, MD MS, Christian A. Barrera, M.D.,
Suraj Serai, Jie C. Nguyen; Children’s Hospital of Philadelphia,
Philadelphia, PA
Disclosures: David M. Biko, MD: Financial Interest: Wolters
Kluwer - Royalty: Editor of Review Book. All other authors
have disclosed no financial interests, arrangements or
affiliations in the context of this activity.
Purpose or Case Report: To investigate magnetic resonance
(MR) imaging features of sacroiliac joint infections in children
with respect to age and with clinical correlation.
Methods & Materials: This IRB-approved, HIPPA compliant
study included 40 MR studies with sacroiliac joint infections
from 40 children (mean age 8.62 +/- 6.1 years; 19 boys and 21
girls) performed between December 1, 2002 and July 31, 2018.
Infections were established using a combination of positive
cultures, elevated inflammatory markers, clinical assessment,
and response to antibiotic treatment. MR studies were
retrospectively reviewed by 2 radiologists in consensus for the
presence of bone marrow edema, bony erosions, joint effusion,
extracapsular edema, soft tissue abscess, and sciatic neuritis.
Pre-treatment radiography was reviewed for the presence of
radiographically visible osseous change. Clinical chart review
was performed for clinical history and outcomes. Descriptive
data is presented as mean ± SD. The inter-observer agreement
was evaluated with weighted-kappa. Kappa scores (k) of 0.41–
0.60, 0.61–0.80 and ≥0.80 were regarded to be indicative of
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S198
moderate, good, and excellent agreement, respectively. Non-
parametric, Chi-square and Fisher tests were used, p < 0.05 was
considered significant.
Results: A bimodal age distribution for infectious sacroiliitis
was identified with 40% (16/40) from children ≤ 5 and 60%
(24/40) from children ≥ 8 years of age. No difference was found
between the groups in the presence of bone marrow edema,
bony erosions, joint effusion, and soft tissue abscess. Although
anterior extracapsular edema was present in all patients,
posterior extracapsular edema was more common in the
younger age group (p=0.006, k=0.923). Radiographically visible
osseous changes were often not present at the time of diagnosis.
80% of patients had diagnostically adequate radiography within
a month prior to MRI (3.6 ± 4.6 days between studies). The
ability to identify infection using radiography was poor, at 31%.
Clinically, the mean duration of symptoms was 8.6 ± 7.4 days
and length of hospital stay was 7.8 ± 4.1 days, which did not
differ between the age groups (p=0.28 for symptom duration,
p=0.24 for hospital stay).
Conclusions: Clinical findings and many of the MR imaging
features of infectious sacroiliitis in children did not significantly
differ with respect to age. Posterior extracapsular edema was
more common in younger children, which suggests regional
ligamentous and capsular laxity and immaturity.
Poster #: SCI-043
Dynamic Contrast-Enhanced MRI Using a 3D Radial
Acquisition: Potential Applications in Musculoskeletal and
Bone Marrow Assessments
Mitchell Rees, [email protected]; Kathryn
S. Milks, MD, Ramkumar Krishnamurthy, PhD, Rajesh
Krishnamurthy, Houchun Hu, PhD; Radiology, Nationwide
Children's Hospital, Columbus, OH
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: There is limited understanding and
utilization of dynamic contrast enhancement MRI of marrow,
periosteum and cartilage for diagnosis of musculoskeletal
(MSK) disease in children. This is partly due to limited
availability of pediatric disease models of marrow
inflammation, infection, infiltration, or involvement by tumor.
Herein we explore signal intensity time curves of relevant MSK
targets using a 3D Golden-angle RAdial Sparse Parallel
(GRASP) MRI technique. GRASP is an accelerated, free-
breathing dynamic acquisition that has been shown to reduce the
need for sedation. We aim to establish a baseline for normal
enhancement characteristics of marrow, cartilage, synovium and
periosteum of the growing skeleton in a sheep model as a
precursor to translation to children.
Methods & Materials: GRASP data were acquired in 4 sheep
using standard dose gadobutrol at 3 mL/sec. All studies were
performed on a 3T system. GRASP data are acquired with
consecutive radial spokes that are rotated by the golden angle.
The data can be reconstructed into time-resolved dynamic
frames with user-selectable temporal resolution during contrast
passage (https://cai2r.net/research/radial-vibe-sequence). We
reconstructed at a temporal resolution of 4.5s. Signal intensity
curves were generated from regions-of-interests in: marrow of
diaphysis, metaphysis, and epiphysis of the humerus, proximal
humeral physis, periosteum of the proximal humerus, a thoracic
vertebral body and an adjacent intervertebral disc.
Results: A sample data set is here
https://www.dropbox.com/s/zmh5dakn847s6w0/20180727.mov
All structures exhibited onset of contrast-enhancement within
approximately the same time frame after contrast
administration, with a time to peak signal of <10s and with little
washout over 180 seconds. There was no difference in the slope
of wash-in and wash-out. However, the peak signal varied by
anatomy. Specifically, signal in the diaphyseal marrow
increased from 16% to 31% above baseline; metaphyseal
marrow: 56% to 246%; physis: 155% to 206%; epiphyseal
marrow: 54% to 96%; periosteum: 62% to 339%; intervertebral
disc: 65% to 118%; and vertebral body: 155% to 321%.
Conclusions: GRASP allows rapid free-breathing
characterization of contrast ehancement in the growing skeleton.
It provides excellent anatomic delineation and can potentially
demonstrate difference in peak signal between relevant MSK
targets. We hope to translate our technique to children, and
utilize it for qualitative and quantitative diagnosis of pediatric
MSK disease.
Poster #: SCI-044
Capitellar-radial distance (CRD): a new standardized
measurement for determining developmental maturity in
younger pediatric patients.
Dustin G. Roberts, M.D. Candidate, 20191,
[email protected]; Soni Chawla, M.D.2; 1David
Geffen School of Medicine at UCLA, Los Angeles, CA, 2Olive
View-UCLA Medical Center, Sylmar, CA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To date, a standard for CRD has not
been established. Plain radiographs are a cost-effective, low-risk
option for studying osseous structures in great detail. It is well
known that bone age is superior to chronological age for
determining biological and structural maturity; for decades,
pediatricians have relied on plain films of the wrist and hand for
assessing bone age in children (e.g. Greulich & Pyle Atlas,
Tanner Whitehouse Method). However, some have proposed
new approaches with greater accuracy and reliability across all
ages and ethnic groups. Here, we present a new standardized
radiographic dimension, CRD, as a tool to assess developmental
maturity, which can be readily obtained from standard medical
imaging platforms.
Methods & Materials: X-rays of the elbow were systematically
searched in the electronic medical record at a single institution
from a 15-month period (June 1, 2017 – Sept 30, 2018).
Inclusion criteria included patients <18 years of age with plain
films in anteroposterior (AP) and lateral views. Patients with
radial head dislocation, displaced supracondylar fractures, or a
history of dysplasia were excluded. Follow up images were also
excluded. CRD values, measured as closest linear distance from
the humeral capitellum to the radial head, were measured by a
staff radiologist. P-values <0.5 using a two-tailed Student’s t-
test were deemed to be statisticallysignificant.
Results: 75 patients ages 3 months to 18 years were included in
the study. 45 were male (mean age=10 yrs, range=24 mo-18
yrs) and 29 were female (mean age=9 yrs, range=3 mo-17
yrs).CRD decreased with age, with the most significant drop off
observed after age 5, when most patients developed a radial
head ossification center. Mean AP CRD for ages 5 and below
was 7.25 mm [SD ±1.54 mm], while mean AP CRD for ages 6
and above was 3.41 mm [SD ±0.81 mm] (P <0.0001).
Conclusions: The standard for determining developing skeletal
maturity has historically involved X-rays of the hand and wrist.
However, these methods have shown inconsistency across
certain age groups and ethnic groups. Here, we present another
radiographic measurement to aid in the determination of skeletal
maturity. CRD proves to have a strong negative curvilinear
relationship with increasing age, particularly from ages 3
months to 5 years, before many healthy patients have developed
a radial head ossification center and thus demonstrate largest
CRD values. Knowledge of this measurement will aid diagnosis
of radial head subluxation.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S199
Poster #: SCI-045
Mycobacterium bovis osteitis following immunization with
Bacillus Calmette-Guérin (BCG): Clinical and Imaging
Characteristics
Jung-Eun Cheon, [email protected]; Eun Hwa Choi, MD,
Won Joon Yoo, MD, Young Hun Choi, In-One Kim, Woo Sun
Kim; Radiology, Seoul National University College of
Medicine, Seoul, Korea (the Republic of)
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Mycobacterium bovis BCG osteitis, a
rare complication of BCG vaccination. The aims of this study
were to evaluate the clinical and imaging characteristics of BCG
osteitis.
Methods & Materials: Twenty children with BCG osteitis at
the Seoul National University Children’s Hospital from January
2007 to March 2018 were included [M:F=13:7, median age at
symptom onset:15 months (range: 7-34 months)]. M. bovis
BCG osteitis was confirmed by multiplex PCR in the affected
bone. BCG immunization status, clinical information,
radiological findings [plain radiography and MRI (all),
ultrasonography (n=9), and CT (n=1)] were reviewed
retrospectively.
Results: Most common presenting symptoms were soft tissue
swelling and pain (n=13, 65%) while fever was accompanied
only in three patients (15%). Median duration of symptom was
1 month (range: 2 days-3 months). Leukocytosis and elevation
of C-reactive protein (CRP, > 0.5 mg/dL) were depicted in three
(15%) and seven patients (35%), respectively. Sixteen children
(80%) received Tokyo-172 vaccine by percutaneous multiple
puncture method, three (15%) and one (5%) received
intradermal Tokyo-172 and Danish strain, respectively. Distal
femur (n=7) was the most frequently involved site followed by
tarsal bones (n=4), proximal tibia (n=2), distal humerus (n=1),
distal radius (n=1), sternum (n=1), rib (n=1) and proximal
phalanx of big toe (n=1). Epiphyseal involvement of the long
tubular bones were seen in seven patients (35%). Multiple bone
lesions were depicted in two patients. Plain radiography showed
ill-defined osteolytic lesion with cortical disruption in 13
patients. MRI showed central necrosis in the involved marrow
cavity with cortical destruction and cold abscess formation in 14
patients (70 %). Surgical drainage was performed in 19 patients
(95%), and half of them required repeated surgical interventions
due to recurrent infection. Antituberculosis medications were
administered for a median duration of 12 months (range, 12-31
months).
Conclusions: BCG osteitis in immunocompetent children is a
rare but serious complication of BCG immunization. High level
of suspicion of BCG osteitis based on clinical and radiological
manifestations is important for early diagnosis and prompt
management.
Poster #: SCI-046
Automated analysis of bone health and bone age from hand
radiograph in children with Duchenne muscular dystrophy
Jonathan Bowden, [email protected]; Sasigarn
Bowden, Brent Adler, MD, Houchun Hu, PhD, Rajesh
Krishnamurthy, Ramkumar Krishnamurthy, PhD; Radiology,
Nationwide Children's Hospital, Columbus, OH
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Children with Duchene muscular
dystrophy (DMD) have increased risk for osteoporosis and
fragility fractures due to progressive muscle weakness with
eventual loss of ambulation and chronic corticosteroid therapy.
Their fracture prevalence is 40-60%, and increases with age.
Bone Mineral Density (BMD) is not reflective of fracture risk.
Recent studies showed that cortical thickness and area were
associated with increased facture risk. Digital X-ray
measurement of the cortical thickness of the metacarpal bones
can be used as a marker for metacarpal cortical health. To our
knowledge, this marker of bone health has not been evaluated in
DMD patients. The purpose of this study was to assess bone age
(BA), cortical thickness and area of metacarpal bones in relation
to age in children with DMD.
Methods & Materials: In this retrospective IRB approved
study, 47 boys (age range: 3-17 years; mean:11.9 ± 4.5 years)
with DMD who had a bone age radiograph was included.
Automated determination of bone age, and cortical bone density
expressed as Bone Health Index (BHI) were performed using
BoneXpert (Visiana, Holte, Denmark). Validation of bone age
from Bonexpert has been performed extensively before. Z-
scores were computed for bone age and BHI, and age-related
changes were noted. Pearson’s correlation coefficient (r) was
calculated for each metric in comparison to age.
Results: The mean z scores of bone age and BHI reduced
significantly with age. Z-scores for BA and BHI were: 1) 5-8
years (n=7), BA:-0.51; BHI: -1.17; 2) 8-11 years (n=14), BA: -
1.17; BHI: -1.78; 3) 11-15 years ( n=21), BA: -2.36; BHI: -
1.745; 4) 15-17 years (n=4), BA:-3.77, BHI:-2.46. The
Pearson’s r = -0.47 for BA and r = -0.36 for BHI (reduces with
age, p<0.005). The actual BHI with age was: 1) 5-8 years BHI:
3.86 ± 0.38; 2) 8-11 years; BHI: 3.83 ± 0.35; 3) 11-15 years
BHI: 3.76 ± 0.95; 4) 15-17 years ; BHI: 3.84 ± 0.32
Conclusions: We showcase a new metric that looks at bone
health in DMD children, and demonstrate a worsening BHI with
age in DMD patients. BHI may have values in assessment of
bone health in children with DMD. The worsening BHI with
increasing age may correlate with increased fracture risk that is
known to increase over time due to disease progression and
longer corticosteroid exposure. Future study is needed to
determine the association of BHI and fracture risk.
Poster #: SCI-047
3D Printed Patient Specific Surgical Guides for Pediatric
Orthopedic Tumor Resection
Jayanthi Parthasarathy, B.D.S, MS, PhD.D.S., [email protected]; Thomas
Scharschmidt, MD, FACS, MBOE, Mitchell Rees, Bhavani
Selvaraj, MS; Radiology, Nationwide Children's Hospital,
Columbus, OH
Disclosures: Thomas Scharschmidt, MD, FACS, MBOE:
Consultant, Honoraria: Stryker Orthopaedics. All other authors
have disclosed no financial interests, arrangements or
affiliations in the context of this activity.
Purpose or Case Report: We describe a process for pre-
operative virtual surgical planning and creation of patient
specific surgical guides for bony tumor resection in pediatric
orthopedic surgery and demonstrate a case in which this process
was used for successful surgical guidance.
Methods & Materials: Herein we describe the general process
for creating a virtual surgical plan (VSP) and show an example
of a scapula tumor resection aided by a 3D printed surgical
guide.First, a virtual 3D model of the bony anatomy is
reconstructed using pre-operative CT scan images.MRI
sequences that clearly delineate the tumor margins then are
chosen to reconstruct the tumor.Using segmentation, region
growing and 3D modeling algorithms of
MIMICSTM (Materialise,Belgium), 3D models of the region of
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S200
interest (ROI) are created.The CT and MRI sequences are fused
using the image registration algorithms in MIMICSTM.VSP and
creation of patient specific surgical guides:The registered 3D
models are imported into Geomagic Freeform (3D
systems,SC,USA).The program has a force feedback haptic
phantom and tools for cutting, moving, rotating, and creation of
offsets, etc. Resection(osteotomy)planes are created on the
model after due consideration of the safety margin required for
the type of tumor,blood vessels in the line of osteotomy,
preservation of musculoskeletal function, and any other clinical
requirements of the surgeon.The planes are then used to cut the
models, simulating the surgical procedure.Open type or closed
guides are created depending on the anatomical location,tumor
type,surgical plan and surgeon’s preferences.Guides are
designed as an offset of the remaining normal bone along the
osteotomy plan. Screw holes for fixing the guide to the
anatomical region of resection are provided.Bone thickness in
the ROI is provided ahead of surgery for appropriate planning
and preparedness.3D Printing:Designed guides are 3D printed
with autoclavable materials such as DentalSG™resin,ULTEM
9085, and Polyamide or with MED610–Sterrad
sterilization.Patient specific surgical guides so produced are
used in the sterile field and fitted on the ROI.The VSP resection
plan is transferred to the OR and executed precisely.
Results: We utilized this procedure for successful resection of
Ewing’s Sarcoma of the scapula in a 12-year-old, preserving as
much of the patient’s native scapula as safely feasible.
Conclusions: This process can lead to better safety and quality
procedures, eventually leading to better clinical outcomes.
Poster #: SCI-048
Can zone of provisional calcification (ZPC) imaging predict
physeal outcome after fracture?
Deborah Brahee, [email protected]; Andrea
Chan, Kathleen H. Emery, Roger Cornwall, Thomas Maloney;
Cincinnati Children's Hospital Medical Center, Cincinnati, OH
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Physeal injuries can result in
premature physeal fusion. MR imaging is useful for mapping
these bony physeal bridges. Resection of the bony bridge does
not reliably restore normal physeal function. We have observed
subtle loss of the normal low signal intensity line of the zone of
provisional calcification (ZPC) extending beyond areas of
physeal bar formation in some patients with prior growth plate
fractures. This loss is a marker of disrupted endochondral
ossification and likely reflects a more extensive region of
physeal damage that might be used to better predict treatment
outcomes. Given the subjectivity of visual ZPC assessment, we
sought to develop a quantitative 3D map of the periphyseal area
of the distal radius using a high resolution 3D fast/turbo spin
echo sequence.
Methods & Materials: Evaluation of two patients’ wrist MRI
was performed retrospectively with IRB approval. One patient
had a prior Salter–Harris type II fracture of the distal radius with
a bony bar while the second had a normal wrist MRI performed
for non-traumatic reasons.We developed a program to quantify
the MRI signal intensity of the periphyseal region in cross
section using a semi-automated approach to provide a more
accurate assessment of loss of the ZPC. The normally
continuous higher signal band of healthy distal radial physeal
cartilage adjacent to the normal low signal intensity ZPC was
assessed and compared to the normal distal ulnar periphyseal
region. Signal metrics and periphyseal 3D signal maps were
obtained. These were evaluated and compared.
Results: Four signal metrics were calculated producing
associated signal maps that were color coded: Difference in
signal minimums, peak minus minimum ratio, slope of
minimums and voxel distance from ZPC to peak. Comparisons
were made between the distal radius and ulna and between the 2
subjects with fracture and normal wrist. Signal maps
demonstrated visually detectable differences that correlate with
loss of the ZPC surrounding the physeal bridge versus normal
radius and ulna.
Conclusions: Quantifiable changes in the ZPC can be
demonstrated with this model. The model will be applied to
MRI’s in patients with prior growth plate fractures and
compared with clinical outcomes to determine its utility in
providing a more complete assessment of physeal function.
Poster #: SCI-049
Quantitative MRI for Bone Marrow Fat Fraction to
Differentiate Malignant versus Non-Malignant Marrow
Jonathan Samet, MD1, [email protected]; Kristian
Schafernak2, Nicoleta Arva1, Jie Deng3; 1Medical Imaging, Ann
& Robert H. Lurie Children's Hospital of Chicago, Chicago,
IL, 2Phoenix Children's Hospital, Phoenix, AZ, 3Rush
University Medical Center, Chicago, IL
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: MRI interpretation of pediatric bone
marrow is a challenging task due to the highly variable
appearance. The bone marrow composition, especially the
cellularity, changes with age, benign and malignant hematologic
conditions, medications, among other etiologies. Detection of a
marrow replacement process on MRI can be missed even by
experienced radiologists. Normal hematopoietic bone marrow
from birth to 9 years ranges from 20-40% fat (inversely related
to cellularity). In malignant marrow replacement processes such
as leukemia, bone marrow is highly cellular and fat percentage
is low. Currently, no technique is routinely used in clinical
practice to quantify bone marrow fat percentage on MRI.
Methods & Materials: A pilot study of patients with suspected
malignant marrow replacement recruited by convenience
sampling. MRI and bone marrow biopsy were performed within
8 days of one another. Bone marrow biopsy fat % was averaged
between two blinded pathologists. MRI obtained from the
suspected area of symptoms and core bone marrow biopsy
obtained (as standard of clinical care) from the iliac crest. The
MRI technique used was the Dixon technique with fat and water
separation. Fat fraction is calculated based on the ratio of fat
and water proton density. MRI was considered predictive of
malignancy if fat fraction % was less than 20.
Results: Six cases of patients (mean age 7.5y (range 3-14y))
were recruited. Pathologic diagnoses included: leukemia (n=5)
or rhabdomyosarcoma (n=1). MRI was performed and analyzed
from the: pelvis (n=4), spine (n=1), and elbow (n=1). MRI fat%
correlated with pathology, but due to the small sample size was
not significant (r=0.6, p=.20). Inter-pathologist correlation was
high (r= 0.9, p<0.05). Elbow MRI fat% correlated with
pathology (76 v. 67.5%), but was falsely negative in predicting
leukemia. Of all other locations, mean fat percentage calculated
by MRI versus pathology was similar (average± standard
deviation, 3.7± 1.3 v 3.0± 3.0).
Conclusions: MRI can help radiologists detect a malignant
marrow replacement process with more confidence using the fat
fraction technique. Studies are ongoing to compare these cases
to control patients.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S201
Poster #: SCI-050
Pediatric Osteomyelitis (OM) Assessment using a Fat
Suppressed Dynamic 3D Radial Acquisition: Preliminary
Experience
Kathryn S. Milks, MD, [email protected]; Mitchell
Rees, Ramkumar Krishnamurthy, PhD, Houchun Hu, PhD,
Rajesh Krishnamurthy; Radiology, Nationwide Children's
Hospital, Columbus, OH
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To determine if a 3-minute Golden-
angle RAdial Sparse Parallel (GRASP) dynamic contrast
enhanced (DCE) MRI sequence with 8-10 second temporal
resolution is equivalent in diagnostic performance to a
conventional MR sequences (CS) in the assessment of
osteomyelitis (OM) in children.
Methods & Materials: 6 subjects (9m – 23y) with suspected
OM were imaged at 3T as part of an IRB-approved study. The
scans included both conventional sequences (T1, IR, PD, T2-
weighted and T1 fat suppressed postcontrast) for osteomyelitis
as well as a 3-minute GRASP DCE sequence that we have been
concurrently evaluating in a sheep model. CS were interpreted
per clinical standards. GRASP was interpreted independently by
3 radiologists, blinded to CS, and scored with binary (y/n)
answers for reporting elements in OM including marrow signal
abnormality, synovitis, subperiosteal abscess, intraosseous
abscess, soft tissue or muscle hypoenhancement, myositis, and
cellulitis.
Results: Average total exam time for CS protocol was 46.2 ±
15.1 minutes. Average additional time for GRASP was 8 ± 5.1
minutes including prescription and scanning. Average slice
thickness was 3.2 mm for CS and 1.5 mm for GRASP. CS
demonstrated marrow signal abnormality in 4 of 6 cases,
attributed to OM in 3, with one case being posttraumatic.
Synovitis (n=3), soft tissue hypoenhancement (n=3), myositis
(n=2), and cellulitis (n=4) were also identified. There were no
cases of intraosseous or subperiosteal abscess. Based on the
average sensitivity and specificity of the 3 readers, GRASP was
relatively sensitive (83%) and highly specific (100%) in
detection of marrow signal abnormality, highly sensitive
(100%) and specific (89%) for soft tissue or muscle
hypoenhancement, and 100% sensitive and 67% specific for
cellulitis. GRASP was less sensitive than CS for detection of
synovitis (50%) and myositis (50%), with high specificity
(100% and 92% respectively). Locations of disease were
concordant across readers and consistent with CS.
Conclusions: Based on preliminary data in this ongoing study,
GRASP holds promise for replacing CS in the diagnosis of OM
and ultimately reducing sedation. Further analysis is necessary
to determine if the addition of a single precontrast fluid
sensitive sequence and quantitative DCE curves may provide
additional diagnostic benefit.
Poster #: SCI-051
Characterization of T2 Map of Healthy Children and
Adolescent Ankle Cartilage Under Altered Magnetic
Resonance Image Protocols
Haris Majeed, BSc1, Marshall Sussman, PhD2, Brian
Feldman1, Carina Man1, [email protected]; Victor
Blanchette1, Andrea Doria, MD1; 1Diagnostic Imaging, The
Hospital for Sick Children, Toronto, Ontario, Canada, 2Toronto
General Hospital, Toronto, Ontario, Canada
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To evaluate the T2 map relaxation
times in healthy male children and adolescent ankle cartilage
under altered magnetic resonance image (MRI) protocols and to
document trends in these T2 relaxation times with varying ages
and body mass index (BMI).
Methods & Materials: This cross sectional study recruited 11
healthy male children and adolescents (median age of 14 years;
range 8-17 years), who each underwent 3.0 Tesla T2 map MRI
examinations of ankle (tibia-talus) using three protocols.
Protocol 1 – a single echo spin echo constant TR/TE (TE = 13,
19, 28 ms; TR = 513, 519, 528 ms). Protocol 2 – a multi-echo
spin echo (TE = 9.6, 19.2, 28.8 ms; TR = 1000 ms). Protocol 3
(high spatial resolution) – a multi-echo spin echo (TE = 11.1,
22.2, 33.3 ms; TR = 1690 ms). Images were analyzed at sagittal
lateral and medial MRI slices using a house-made MATLAB
software. A P value less than 0.05 was considered statistically
significant.
Results: We found statistically significant negative associations
between age and T2 relaxation times of ankle cartilage, ranging
from -0.91 (P < 0.001) to -0.66 (P = 0.03) for all image
protocols. Furthermore, statistically significant negative trends
of T2 relaxation times for ankle cartilage were found with
increasing age, ranging from -2.08 ms/year (P = 0.006) to -0.80
ms/year (P < 0.01) for all image protocols. Similarly, mean T2
relaxation times were found upon using a constant TR/TE to
other image protocols, thus enforcing the generalizability of the
protocol. In contrast, weak associations were found between
BMI and ankle cartilage T2 relaxation times.
Conclusions: Age plays an important role in understanding
cartilage T2 relaxation times. Additionally a TR/TE protocol
can be used to help optimize scanning time for children and
adolescents.
Poster #: SCI-052
The Role of MR Susceptibility-Weighted Imaging in Acute
Pediatric Seizures: in Relation to Electroencephalographic
Activities
Yongwoo Kim, [email protected]; Jae- Yeon Hwang;
Radiology , Pusan National University Children's Hospital,
Yangsan, Korea (the Republic of)
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To evaluate the relationship between
cortical venous signal and electrographic activity in children
with seizure using magnetic resonance imaging with
susceptibility weighted imaging (SWI) and
electroencephalogrphy (EEG).
Methods & Materials: Children presented with seizures, who
underwent both SWI and EEG within 12 hours after seizure
onset were retrospectively reviewed. An increased signal of
cortical veins (SWI+) was assessed using SWI, while abnormal
activities such as slowing or epileptiform discharges (EEG+)
were investigated on EEG. We defined three groups of patients
in accordance to the topographic correlation between SWI+ and
EEG+: (A) no increased venous flow and no abnormal
discharges, (B) discordant finding between the SWI+ and EEG+
area, (C) concordant distribution between the SWI+ and EEG+
area.
Results: We identified 297 children (194 in group-A, 76 in
group-B, and 27 in group-C). The mean age among the three
groups was similar (group-A =3.5±4.5 years; group-B = 3.1±3.5
years; group-C = 5.2±5.4 years, p=0.079). Multiple seizures
were revealed more frequently in group-C (51.9%) than in
group-A (23.7%) or group-B (39.5%, p=0.002). The incidence
of newly-diagnosed epilepsy was significantly higher in group-
C (20/27, 74.1%, p=0.001) than in group-A (45/194, 23.2%) or
group-B (17/76, 22.4%). By contrast, there were no significant
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S202
differences in seizure duration and seizure types among the
three groups.
Conclusions: Patients with concordant distribution of the
findings between SWI and EEG had significantly frequent
multiple or epileptic seizures. SWI may be helpful to discover
the epileptic focus localization in children with acute seizures.
Poster #: SCI-053
Corpus callosum morphology in children on mid-sagittal
MR imaging
Lauren A. Raubenheimer, MBChB1, [email protected]
Savvas Andronikou, MBBCh, FCRad, FRCR, PhD (UCT), PhD
(Wits)2, Tracy Kilborn1; 1Radiology, University of Cape Town,
Cape Town, Western Cape, South Africa, 2University of Bristol,
Bristol, United Kingdom
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: There is little published research on
the wide variation of corpus callosum (CC) morphology in
children, the assessment of which is made difficult by the
complex alteration of its appearance in childhood. The purpose
of our study was to assess the morphology of the CC on mid-
sagittal T1-weighted magnetic resonance imaging (MRI) in a
large number of children and correlate the findings with
demographic and clinical criteria.
Methods & Materials: We reviewed all mid-sagittal T1-
weighted brain MRI’s performed from July to December 2015
and obtained relevant demographic and clinical information
from the accompanying report and laboratory system. The CC
morphology was analysed by three radiologists and compared
using cross tabulation with the chi-square test and ANOVA.
Interobserver correlation was assessedusing Kappa coefficient
of conformance.
Results: 257 children (mean age 72±60 months) were included,
(142 male; 55%). In abnormal MRI’s the CC was less likely to
have an identifiable isthmus and more likely to be convex, thin
and have separation of the fornix insertion (all p<0.01). In
young children (< 5 years) the CC was also less likely to have
an identifiable isthmus (p=0.01) and was more likely to be
convex (p=0.04) but the fornix was more likely to insert
normally (p<0.01).
Conclusions: There is a distinct pathological appearance of the
CC. The immature appearance of the corpus callosum can
mirror this but is distinguished by normal insertion of the fornix
and normal quantitative measurements.
Poster #: SCI-054
Evaluation of lymphocytic thyroiditis in children with
quantitative gray-scale ultrasound using a PACS-based tool
Aneliya Maleeva, [email protected]; Jennifer E.
Lim-Dunham, MD, Iclal E. Toslak, MD, Brendan Martin, Phd,
Davide Bova, Aishe I. Kilic, Guliz Barkan; Radiology, Loyola
Medical Health Care System, Vernon Hills, IL
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To evaluate diagnostic performance
of quantitative gray-scale ultrasound as an objective method in
evaluation of pediatric thyroiditis.
Methods & Materials: In this retrospective study of 37
children with tissue proven diagnosis, two radiologists
independently reviewed thyroid ultrasounds twice and
subjectively classified images according to presence or absence
of thyroiditis. A consensus session was performed for patients
for which there was disagreement. Unweighted kappa
coefficients were calculated to assess intra- and inter-observer
reliability. Pearson chi-square and Fisher’s exact tests were used
to compare categorical measures by final pathology.A third
radiologist performed quantitative measurements of echo-
intensity level of the thyroid and adjacent strap muscles from
US images using a PACS-based tool. Thyroid /muscle ratio
(TMR) was obtained by dividing thyroid mean by muscle mean
values. Heterogeneity index (HI) for thyroid was calculated by
dividing thyroid SD by thyroid mean values. Wilcoxon Rank
Sum tests were used to assess distribution of continuous risk
factors by final pathology.
Results: Patient group comprised 29 females and 8 males, with
median age 17 years (interquartile range 15-18). By pathology,
19 (51.3%) patients had lymphocytic thyroiditis and 18 (48%)
had normal thyroid. For subjective assessment, there was fair
inter-observer agreement (kappa .36 (95% CI .14-.57), p=.004)
and slight intra-observer agreement for each radiologist (kappa
.13 and .17, p>.05). A large proportion of patients for whom
consensus review indicated thyroiditis were confirmed with
pathology (12/19 (63%), p=.03). For quantitative assessment, no
significant difference between thyroiditis and normal thyroid
groups was found for either TMR (1.51 and 1.62, respectively,
p=.82) or HI (.23 and .23, respectively, p=.37).
Conclusions: Quantitative gray-scale ultrasound did not
accurately diagnose thyroiditis. However, subjective consensus
evaluation showed significant correlation with the condition,
suggesting that multiple radiologists performing more than one
review may be beneficial for accurate diagnosis of thyroiditis in
children.
Poster #: SCI-055
Does a decrease in hematocrit predict intracranial
hemorrhage on neonatal head ultrasound?
Matthew O. Thompson, MD1, [email protected];
Joseph Davis, MD1, Atalie C. Thompson, MD1, Nathan Hull,
MD2, Gary Schooler, MD1; 1Pediatric Radiology, Duke
University, Durham, NC, 2May Clinic, Rochester, MN
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: The purpose of this study is to
determine whether a decrease in hematocrit is predictive of an
intracranial hemorrhage (ICH) on neonatal head ultrasound
(HUS).
Methods & Materials: This is a retrospective study of 136
neonatal HUS between 2005 and 2017 at a single institution.
The indication for the HUS was categorized as being related to
hematocrit (e.g. “drop in hematocrit”) or unrelated to
hematocrit. The medical record was also reviewed for the
change in hematocrit in the 48 hours prior to HUS, a decrease in
hematocrit, gestational age, number of days since birth,
prematurity, and abnormal neurologic exam. The association
between these variables and the presence or absence of
hemorrhage on the HUS was analyzed using STATA 12.1.
Results: Twenty-one percent (N=29/136) of neonates had an
ICH on their HUS. Studies that were ordered with an indication
related to hematocrit were less likely to have an ICH on HUS
compared to those with alternative indications for the study
(odds ratio 0.35, p=0.018). The mean change in hematocrit
(p=0.95), a decrease in hematocrit (p=0.30), and an abnormal
neurological examination (p=0.25) were not associated with
ICH on HUS. However, a lower gestational age (mean
difference 4.47, p<0.001) and number of days since birth (mean
difference 25.1, p=0.01) were both significantly predictive of
ICH. Those with an ICH were also three times more likely to be
premature, though this association was only borderline
significant (odds ratio 3.03. p=0.09).
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S203
Conclusions: A decrease in hematocrit in the preceding 48
hours is not predictive of an ICH on neonatal HUS. Those with
ICH on HUS had a significantly lower gestational age and were
more likely to be born premature.
Poster #: SCI-056
Regional Differences in Paranasal Sinus Mucosal
Thickening: Implications For Neutropenic Febrile Children
Susan E. Schmidt, MD, [email protected]; Joseph
Cao, Cory Pfeifer; Radiology, UTSW, Fort Worth, TX
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: The diagnostic approach to fever of
unknown origin (FUO) in a neutropenic child is challenging.
Recommendations of the Children's Oncology Group and the
ACR provide some guidance, but evidence basis for use of sinus
CT in the acutely febrile neutropenic child is poorly established.
This presentation assesses baseline paranasal sinus mucosal
thickening in children in 2 separate cities and compares them to
children with neutropenia undergoing sinus CT in the work-up
of FUO.
Methods & Materials: Data collected from 2 large children's
hospitals in major metropolitan cities in the southern US.
Hospital A is in a desert climate, Hospital B is in a humid
subtropical climate. 18 consecutive sinus CTs were reviewed in
neutropenic children undergoing diagnostic evaluation for FUO
at Hospital A. Bone marrow transplant patients were excluded.
All children were oncology patients undergoing treatment.
Control groups used include 18 consecutive patients at hospital
A and 18 consecutive patients at hospital B who presented to the
ED requiring CT of the face. Control patients with a history of
sinusitis, patients with a facial bone fracture, and patients with
any oronasal support devices were excluded. No exams of
neutropenic fever patients at hospital B were available, hospital
B uses nasal endoscopy to assess for sinus disease in this
population. Lund-Mackay (L-M) and modified Lund-Mackay
scores were applied to all CT scans.
Results: The mean age in the neutropenic fever group was 9.86
years. The mean ages of hospital A and B control groups were
8.16 and 8.34 years, respectively. Age differences were not
significantly different using a Student t-test. LM scores in the
hospital A control group exhibited a mean of 5.50 with a mean
modified-LM score of 6.92. Corresponding values in the
hospital B control group were 3.11 and 4.00, respectively. In the
neutropenic fever group of hospital A, the mean LM and
modified-LM scores were 4.17 and 4.59, respectively. Findings
viewed as "positive" in the neutropenic fever group resulted in 2
infectious disease and 2 ENT consults. All 4 consults concluded
that fever was unlikely to be due to paranasal sinus disease, no
intervention recommended.
Conclusions: Mucosal sinus thickening is omnipresent in
children and can vary based on region. Baseline paranasal sinus
mucosal thickening is greater among children living in a desert
climate. The description of paranasal sinus mucosal thickening
in neutropenic children may be of little value in the approach to
fever without source.
Poster #: SCI-057
Variation In Conspicuity Of Focal Cortical Dysplasias And
Its Effect Upon Ease Of Detection
John Vu, MD, MPH, [email protected]; Matthew
Parsons, Markus Zei, MD, Aseem Sharma, MD; Mallinckrodt
Institute of Radiology, Saint Louis, MO
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Detection of focal cortical dysplasias
(FCDs) can be challenging. Our aim was to evaluate
quantitative contrast differences between FCDs and the mirror-
location normal gray matter, and the effect thereof on the ease
of detection by radiologists.
Methods & Materials: Coronal FLAIR and T1WI of 20
pathology proven cases of FCD, including 11 cases where the
diagnosis was missed on the initial review, were analyzed. CNR
and conspicuity differences between gray matter within FCDs
and contralateral mirror image locations were calculated using
manually drawn ROIs. Similar calculations were made in 20 age
and gender matched controls for lateralized differences in
normal gray matter at locations equivalent to those of FCDs.
Results: On FLAIR images, median (25th percentile,
75th percentile) CNR and conspicuity for FCD was 11.3 (8.5,
20.9) and 10.2 (7.1, 15.4), significantly higher than
corresponding CNR of 1.0 (-0.2, 5.5) and conspicuity of 0.8 (-
0.2, 2.8) for controls (p<0.0001 for both). Similarly, CNR and
conspicuity for FCD was also higher than controls on T1WI
(p<0.0001). Subgroup analysis showed that these differences
from normal were maintained irrespective of FCD detection or
lack thereof at the initial review. Median CNR and conspicuity
on FLAIR (p = 0.79 and 0.07 respectively) and T1WI (p = 0.64
and 0.76 respectively) were not significantly different for FCD
cases that were detected and those that were missed on the
initial review.
Conclusions: Focal cortical dysplasia lesions have significantly
higher CNR and conspicuity relative to mirror-location gray
matter when compared to age and sex matched controls. These
differences exist even in cases that were missed at the time of
initial review. Accentuation of such differences may serve as a
means to improve detection of FCDs.
Poster #: SCI-058
Fidelity of 3DPrinted patient specific functional brain
models from multi sequence MRI and their clinical utility in
pediatric epileptic patients with focal lesions
Jayanthi Parthasarathy, B.D.S.,M.S.,PhD,
[email protected]; Satya
Gedela, Adam Ostendorf, Jonathan Pindrik, jeremy Jones,
MD, Aaron S. McAllister, MD, Bhavani Selvaraj, MS,
Alexander Long, Bachelors; Radiology, Nationwide Children's
Hospital, Columbus, OH
Disclosures: Aaron S. McAllister, MD: Equity Interest/Stock
Option: GE, MMM, CHD, JNJ. All other authors have disclosed
no financial interests, arrangements or affiliations in the context
of this activity.
Purpose or Case Report: Establish and evaluate a process for
3DPrinting (3DP) patient specific functional anatomical models
of the brain from multiple MRI sequences in patients with
epileptic focal lesions.The second objective was to evaluate the
clinical utility of the models.
Methods & Materials: Eight patients with intractable epilepsy
and focal lesions in the brain were selected for the study.Data
acquisition:T1 and T2 weighted MR images with DTI fiber
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S204
Tractography were acquired on GE Medical systems, Siemens
Prisma and Skyra MRI scanners with a field strength of 3
TESLA.Slice thickness range-1.00-1.6mm and the slice
increment was 0.5-1mm.Image data processing:Using the
segmentation,region growing and 3D modeling algorithms of
MIMICSTM(Materialise, Belgium)3D virtual models of the
structural anatomy of the affected hemisphere and the lesion
were created. DTI fiber tracts and the vasculature were
segmented from DynasuiteTM(InvivoInternationalUSA)and
exported as DICOM data.3D models of the vasculature and the
DTI FIBERs were created and integrated into the structural
model of the brain.3DPrinting:After preprint preparation the
with Geomagic Freeform(3Dsystems,SC,USA)the model were
printed with Stratasys PolyjetCONNEX 3 Objet 350 multicolor
printer.Models were post processed with high-pressure
waterjet.Model verification:The 3DP models were scanned
with Toshiba Aquilion CT scanner with a slice thickness and
slice increment of 0.5mm.The Dicom image data was imported
into MIMICSTM and a 3D model created.The model so created
was overlayed on the virtual model created from the MRI data.
Surface variation of the 3DP model and the virtual model
created from MRI data was mapped with 3MaticsTM.Models
were resliced into 2D contours and overlayed on the MRI image
dataset for verification.3DP models of the brain were used for
team discussion,resident and fellows and patient education of
the specific neuro anatomy.
Results: Comparative analysis of the CT 3DP model and the 3D
models created from 2D MRI image data showed a mean
difference of -0.36 mm with STD Dev.+/-0.5mm.
Conclusions: Precise patient specific functional anatomic brain
models can be created from multiple MRI sequences using 3D
modeling and Polyjet printing. 3DP patient specific models are
a valuable adjunct to neurosurgical planning. Brain models help
surgeons to educate the patients, parents, residents and fellows
to understand neuroanatomy better.Parents understand the
clinical situation and suggested treatment implications better
and give better informed consent.
Poster #: SCI-059
Complex-Valued Convolutional Neural Networks for MRI
Reconstruction
Elizabeth Cole, [email protected]; John Pauly,
PhD, Shreyas Vasanawala, MD/PhD, Joseph Y. Cheng,
PhD; Electrical Engineering, Stanford University, Stanford, CA
Disclosures: Shreyas Vasanawala, MD/PhD: Arterys,
Royalty: Arterys, GE Healthcare, Siemens, Philips, Research
Grants: GE Healthcare; Joseph Y. Cheng, PhD: Consultant,
Honoraria: HeartVista, Inc., Research Grant: GE Healthcare. All
other authors have disclosed no financial interests, arrangements
or affiliations in the context of this activity.
Purpose or Case Report: Convolutional neural networks
(CNNs) have proven to be valuable in the fields of image
processing and computer vision. Our work applies complex-
valued CNNs to magnetic resonance imaging (MRI) to reduce
scan times. The reduction of scan times has widespread
pediatric benefits. A typical scan requires that patients remain
still for up to an hour to produce a clear image, which is
difficult for children without inducing anesthesia, which carries
risks. A need exists for greatly improved MRI scan times
without the loss of diagnostic accuracy. This scan time can be
reduced by subsampling in k-space. We use CNNs to
reconstruct images from these undersampled acquisitions. Our
work investigates complex-valued CNNs for image
reconstruction in lieu of two-channel real-valued CNNs.
Methods & Materials: Recent work suggests complex-valued
CNNs could be more accurate than real-valued CNNs when
dealing with complex-valued data. Typically, complex-valued
data is fed into CNNs by using a 2-channel architecture where
the channels contain the real and imaginary components of the
data. This does not preserve phase information, which is
valuable for many MRI applications. Recent work in applying
complex-valued CNNs to music transcription and speech
prediction tasks demonstrates complex-valued models are
highly competitive with their real two-channel counterparts
(Trabelsi et al., 2018). Complex-valued neural networks have
been applied to MRI fingerprinting with improvements in
accuracy in comparison to real models (Virtue et al., 2017).We
apply complex-valued CNNs to subsampled image
reconstruction by modifying components of our current CNN
within our deep unrolled architecture to be complex-valued. We
perform complex convolution and explore various complex-
valued activation functions which keep the pre-activated phase
intact, as well as activation functions which are based on the
phase component. We evaluate the performance in terms of
accuracy of this complex model compared to its real
counterpart.
Results: We trained two otherwise identical CNNs with real-
valued convolution and complex-valued convolution, and
approximately 900K trainable parameters each. The validation
loss was 0.693 and 0.639, respectively. This shows complex-
valued networks have the potential to be much more accurate
than their real-valued counterparts.
Conclusions: Our work shows potential for reducing MRI scan
times by more accurately reconstructing images from
subsampled data acquisitions using complex-valued CNNs.
Poster #: SCI-060
Impact of diffusion-weighted sequences in 18F-FDG
PET/MR whole-body pediatric oncologic imaging
Vanessa Sanders, [email protected]; Geetika
Khanna, Joyce Mhlanga, MD, Maria R. Ponisio, MD;
Mallinckrodt Institute of Radiology, St. Louis, MO
Disclosures: Geetika Khanna, MD, MS: Financial Interest:
Elsevier - Royalty: Independent contractor. All other authors
have disclosed no financial interests, arrangements or
affiliations in the context of this activity.
Purpose or Case Report: To determine if diffusion weighted
imaging (DWI) adds value to PET/MRI in pediatric solid
tumors.
Methods & Materials: After obtaining IRB approval, all
pediatric simultaneous PET/MR studies with DWI performed
between April 2015 and August 2017 were concurrently
interpreted by 2 blinded readers (board certified pediatric and
nuclear medicine radiologists) in 2 sessions. In session 1, the 2
readers had access to whole body PET, Dixon, and HASTE
images. Images were assessed for quality, number and location
of lesions, designation as malignant or not. After 6 weeks, in
session 2 the above images were re-reviewed by same readers
with DWI added, for the above assessment with the added value
of DWI. The results of the two sessions were compared by an
independent reviewer.
Results: PET/MR with DWI was available in 20 cases (10
boys), age range: 5 months-18 years (median 10.7 years).
Tumors included: rhabdomyosarcoma (6), Ewing sarcoma (4),
neurofibromatosis-1 (5), post-transplant lymphoproliferative
disease (2), clear cell renal carcinoma (1), squamous cell
carcinoma (1), and neuroblastoma (1). A total of 44 lesions
were identified in session 1; 23 designated malignant and 21
benign. DWI did not detect any additional distant foci of disease
in session 2. No change in final diagnosis or local extent of
disease was noted in 19/20 cases. In one patient with Ewing
sarcoma the local extent of osseous tumor was greater with
DWI than with PET.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S205
Conclusions: Diffusion weighted imaging had no impact on
distant staging in our pediatric cohort, but may add value in
local staging. Routine performance of whole body DWI can be
eliminated and limited to the region of interest in pediatric
patients undergoing PET/MRI to improve patient throughput.
Poster #: SCI-061:
Ultrasensitive detection of translocations in the cell free
DNA of pediatric sarcoma patients
Heike E. Daldrup-Link, MD, PhD1, Avanthi Shah, MD2,
Frederick M. Wittber, MD1, [email protected];
Tej Azad1, Jake Chabon1, Stan Leung2, Aviv Spillinger2,
Heng-Yi Liu2, Marcus Breese2, Maxamilian Diehn1, Ash
Alizadeh1, Alejandro Sweet-Cordero1; 1Radiology, Stanford,
Palo Alto, CA, 2UCSF, San Francisco, CA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Currently, biopsy serves as the gold
standard to accurately diagnose disease in pediatric sarcoma
patients, but the risks of anesthesia and surgery, along with a
failure to characterize the true heterogeneity of disease make
this method less than ideal. Progression and response to therapy
are monitored by radiologic exams which lack the sensitivity to
detect early relapse. Cell free DNA (cfDNA) is released into the
plasma as they undergo apoptosis and necrosis. ctDNA
represents a small fraction of cfDNA in cancer patients and
contains tumor specific alterations. It holds promise as a highly
sensitive and specific biomarker. A limitation in applying liquid
biopsy in clinical practice is the need to develop PCR or other
DNA analysis methods to detect alterations specific to a single
patient. We have developed a more widely applicable off the
shelf test that does not involve a patient specific design.
Methods & Materials: Our CAPP Seq technique involves
designing a selector comprised of custom designed
oligonucleotide probes that tile across genomic regions of
interest. These oligonucleotide probes are used to enrich for the
relevant ctDNA via hybrid capture, followed by ultra deep
sequencing to analyze alterations in the selected regions. Our
selector was applied to pretreatment plasma samples from
newly diagnosed or newly relapsed pediatric sarcoma patients.
Plasma samples were analyzed at key timepoints over the course
of treatment.
Results: Pediatric sarcoma patients had higher levels of cfDNA
when compared to published levels in adult cancer patients.
Canonical translocations were detected in the plasma of 13/14
(93%) pediatric sarcoma patients. This was confirmed by
analysis of matched tumor samples, when available. Patients
with metastatic disease had higher ctDNA levels compared to
nonmetastatic patients. ctDNA levels correlated with
clinicalcourse and, in some cases, rising ctDNA levels predicted
relapse, earlier than was clincally apparent by imaging studies.
Conclusions: ctDNA analysis holds promise as an ultrasensitive
and specific tool for monitoring tumor burden. Our assay was
able to detect ctDNA in the plasma of metastatic and
nonmetastatic pediatric sarcoma patients at diagnosis.
Furthermore, we demonstrated that ctDNA levels correlated
with clinical response to therapy. In some cases, ctDNA levels
proved more sensitive than imaging, detecting minimal residual
disease andpredicting relapse.
Poster #: SCI-062
Pediatric Nuclear Medicine After Hours: Exploring the
Need for On-Call Nuclear Medicine Training
Jennifer Gillman1, [email protected]; Janet R.
Reid, MD, FRCPC2, Sabah Servaes2, Hongming Zhuang2, Lisa
States2; 1Diagnostic Radiology, Hospital of the University of
Pennsylvania, Philadelphia, PA, 2Children's Hospital of
Philadelphia, Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Experience in pediatric nuclear
medicine is limited and not uniform across residency and
pediatric fellowship training programs. At our tertiary care
pediatric hospital, emergent nuclear medicine exams performed
after hours are currently read by radiologists with expertise in
pediatric nuclear medicine. A decision to shift this responsibility
to in-house faculty has prompted creation of a continuing
medical education (CME) learning module as part of an
institutional comprehensive learning management system
(LMS). The goal of this module is to train faculty, fellows and
residents in the indications, protocols, diagnostic criteria,
potential pitfalls and problem-solving techniques when reading
emergent pediatric nuclear medicine exams. The purpose of this
study is to better understand the volume of nuclear medicine
cases on-call and the potential need for a dedicated pediatric
nuclear medicine curriculum.
Methods & Materials: All nuclear medicine gastrointestinal
bleeding scans, Meckel’s scans, hepatobiliary scans for biliary
leak or acute cholecystitis, brain death scans and renal
transplant evaluations performed between July 1, 2017 and June
30, 2018 were reviewed. Exams ordered after 4:30 PM on
weekdays or performed on weekends were considered call
studies. Faculty were surveyed to assess length of time since
reading each type of scan, as well as their level of comfort
protocolling and interpreting studies.
Results: Case review revealed 54 emergent pediatric nuclear
medicine studies with 13 (24.1%) read after hours. Of all studies
performed, 28.6% of gastrointestinal bleeding studies (n= 2/7),
16.7% of Meckel’s scans (n= 5/30), 22.2% of brain death
studies (n = 2/9), 33.3% renal transplant scan (n=1/3), 75.0% of
acute cholecystitis scans (n=3/4) and 0% of biliary leak scans
(n=0/1), were read on-call. 19 (70.4%) of 27 faculty members
who take call completed the survey. At least 63.2% have not
read any of these types of nuclear medicine study since
residency/fellowship or not at all. The percentage of those
uncomfortable protocoling studies ranges from 73.7% to 89.5%,
greatest with renal scans. The percentage of those
uncomfortable interpreting studies ranges from 47.4% to 84.2%,
greatest with renal scans.
Conclusions: Even in large academic centers, there is a limited
number of radiologists with expertise in pediatric nuclear
medicine, making call coverage challenging. There is a need for
continued training to provide important emergent nuclear
medicine studies for patients after hours.
Poster #: SCI-063
Does a skeletal survey detect additional bone lesions of
Langerhans Cell Histiocytosis in children undergoing 18F-
FDG Positron Emission Tomography-Computed
Tomography?
Rosemond N. Aboagye, BSc Med Sci, MB ChB,
[email protected]; Lydia M. Bajno, MD, Helen
R. Nadel, MD FRCPC, James E. Potts, PhD, Heather Bray,
MD; Radiology, BC Children’s Hospital, Vancouver, British
Columbia, Canada
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S206
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Purpose: 18F-FDG Positron
Emission Tomography (PET-CT) has been shown to be superior
to other imaging modalities in assessment of soft tissue
involvement with Langerhans Cell Histiocytosis (LCH) and is
now commonly included in the staging workup of LCH. Our
purpose is to analyze the utility of skeletal survey in addition to
PET-CT scan for detecting bone lesions in children with LCH
and to evaluate if skeletal survey can be eliminated from the
staging workup of LCH in order to reduce radiation exposure.
Methods & Materials: This is a retrospective study of patients
with biopsy-confirmed LCH diagnosed and treated at a tertiary
care children’s hospital between 2013 and 2018. The medical
records, skeletal survey and PET-CT imaging records for
staging and follow-up studies were reviewed. The distribution
and number of LCH lesions on both skeletal survey and PET-
CT were documented from our institution’s PACS. Any reports
with insufficient information or ambiguity were re-evaluated by
a Pediatric Radiologist. Demographic information was recorded
and the concordance between lesions seen on the skeletal survey
and/or PET-CT scan was calculated.
Results: Data from 10 children (60% female) with a median age
of 4.6 years (range from 1 year 7 months to 15 years, 1 month)
are reported. A total of 53 lesions in 40 different bones were
evaluated. Forty-nine per cent of all lesions were identified on
both PET-CT and skeletal survey. PET-CT identified an
additional 34% of lesions not seen on skeletal survey, while
skeletal survey identified 17% of lesions not seen on PET-CT.
There were 9 calvarial lesions, all identified on skeletal survey
while only 4/9 were identified on PET-CT scan. The median
interval between the skeletal survey and PET-CT scan was 2.5
days (1-15 days).
Conclusions: Skeletal survey continues to be important in the
evaluation of LCH patients, especially when assessing lesions
involving the calvarium. This may, in part, be due to the
thickness of the PET-CT slices reducing lesion conspicuity and
the marked avidity of the brain parenchyma on PET-CT
obscuring lesions within the calvarium.
Poster #: SCI-064
mIBG optimized SPECT/CT improves interpretation and
Curie score assignment
Melissa C. Kong, James E. Potts, Helen R. Nadel, MD
FRCPC, [email protected]; BC Children's Hospital,
Vancouver, British Columbia, Canada
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: In the past, neuroblastoma patients
frequently had mIBG and diagnostic CT scans performed at
separate times. This practice sometimes caused issues in
correlating findings from the two imaging modalities. A
retrospective review of our entire experience aimed to confirm
the added value of optimized co-registered contrast-enhanced
diagnostic CT to I-123 mIBG SPECT/CT protocol in children
with neuroblastoma. An additional objective was to identify if
SPECT/CT improved Curie score assignment vs planar
imaging.
Methods & Materials: We previously reported on a limited
recent experience of optimized mIBG SPECT/CT. We have
now completed a retrospective review of 384 SPECT/CT scans
of pediatric neuroblastoma patients (aged 0 to 18 years)
performed from April 2007 to June 2018. Added value of the
co-registered CT was categorized as providing: increased
sensitivity, improved localization, improved tumour delineation,
improved differentiation between malignant and physiological
or benign findings, detection of additional incidental findings,
and/or no additional value when fused with the I-123 mIBG
scintigraphy. Chi-square tests were performed to assess
differences between diagnosis vs follow-up scans with added
value from the co-registered CT. Curie score evaluation was
performed using planar and SPECT/CT imaging.
Results: Of all assessed scans, 70% of co-registered contrast-
enhanced diagnostic CT studies performed as part of the
SPECT/CT scan provided added value (87% of staging scans at
diagnosis (n=47), 67% in follow-up (n=337)). Overall, use of
co-registered CT enhanced diagnostic sensitivity, tumour
localization and delineation, and differentiation of malignant
versus benign findings in many cases, and also identified
additional incidental findings. Curie score assessment was
improved in areas of equivocal lesions involving mainly the
torso and particularly on follow-up examinations.
Conclusions: Optimized mIBG SPECT/CT can reduce the need
for additional imaging studies by improving accuracy of disease
characterization and Curie score.
Poster #: SCI-065
The value of physical and psychological distraction methods
in reducing pain in paediatric nuclear medicine procedures.
Mandy L. Kohli, BASc, M.R.T(N), [email protected];
Reza Vali, Afsaneh Amirabadi, Caroline Frankfurter
Frankfurter, Ontario, Amer Shammas; Nuclear Medicine, The
Hospital for Sick Children, Toronto, Ontario, Canada
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: In paediatric nuclear medicine the
majority of the scans require intravenous (IV) access to deliver
the radiotracers. Children and parents often cite procedural pain
as the most distressing part of their child’s hospitalization. In
our department, various pain management strategies including
physical and psychological distraction methods and
pharmacological intervention have been implemented for the
reduction of procedural pain. The purpose of this study was to
evaluate and compare different pain reduction strategies used in
the paediatric Nuclear Medicine department.
Methods & Materials: The chart of 155 children (85 female)
were reviewed retrospectively. Patients were categorized into 4
groups of 1. Maxiline (topical liposomal lidocaine) (n=17), 2.
Pain Ease (vapocoolant) (n=71), 3. oral sucrose (n=48), and 4.
no pharmacological intervention (n=19). Physical and
psychological distraction were used in all patients. Therefore,
group 4 only received physical and psychological strategies.
Physical methods included supportive positioning, deep
breathing, temperature considerations, massage Pressure or
vibration and neonatal development strategies (e.g. non-
nutritive sucking, facilitated tucking, swaddling, rocking).
Psychological strategies included education, distraction with
movies, books or storytelling, relaxation techniques. The pain
perceived by the children after the IV access were compared in
these 4 groups. Two types of pain assessment were used in this
study: 1- Self reporting pain scale, and behavioural
observational pain rating scale. Pain was reported on a scale 1 to
10. The average pain was also compared between patients who
had one or two, and those who had more than two attempts for
IV access.
Results: The average pain score was relatively low in all 4
groups (Maxiline=2.8, pain ease=2.1, sucrose=2.7, and no
pharmacology=3.4). There was no statistically significant
difference between the 4 groups. In particular, although the
average pain was slightly more in patients who didn’t receive
pharmacological intervention, it was not statistically significant.
The average pain was 2.2 with one or two attempts, and 4.8 with
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S207
more than two attempts.
Conclusions: Physical and psychological distraction methods
are useful to reduce the pain in paediatric patients who cannot
receive pharmacological intervention.
Poster #: SCI-066
Evaluation of 3 Tesla Lung Magnetic Resonance Imaging in
children with Allergic Bronchopulmonary Aspergillosis:
Pilot Study
Kushaljit S. Sodhi, MD, PhD, FICR1, [email protected];
Pankaj Gupta1, Akshay Saxena1, Joseph Mathew2, Ritesh
Agarwal1; 1Radiodiagnosis & Imaging, Pgimer,Chandigarh,
Chandigarh, India, 2Pgimer, Chandigarh, India
Disclosures: Ritesh Agarwal: Consultant, Honoraria:
Pulmatrix Inc., USA, Research: Cipla, India. All other authors
have disclosed no financial interests, arrangements or
affiliations in the context of this activity.
Purpose or Case Report: To evaluate the diagnostic
performance of 3 Tesla lung magnetic resonance imaging (MRI)
in children with allergic bronchopulmonary aspergillosis
(ABPA).
Methods & Materials: This study protocol was approved by
the institutional ethics committee and written informed consent
was obtained from parents/ guardians. From October 2015 to
January 2018, we prospectively evaluated twenty-seven
consecutive children with ABPA. The diagnosis of ABPA was
made on the ISHAM-ABPA working group criteria. High
resolution computed tomography (HRCT) and 3T MRI of the
chest was performed on the same day. Bronchiectasis,
consolidation, nodules, and mucus impaction were assessed in
all segments. The sensitivity, specificity, positive predictive
value (PPV) and negative predictive value (NPV) of MRI were
calculated using HRCT findings as the reference standard.
Interobserver agreement was calculated using the kappa
statistic.
Results: The mean age of the patients was 9.89 years (range: 5–
16 years). There were 20 males and 7 females. The sensitivity,
specificity, PPV, and NPV for bronchiectasis was 68%, 100%,
100% and 71.43% respectively. The sensitivity, specificity,
PPV, and NPV for consolidation was 80%, 100%, 100% and
96% respectively. For detection of nodules, the sensitivity,
specificity, PPV, and NPV was 75%, 100%, 100% and 88.46%
respectively. There was 100% sensitivity, specificity, PPV and
NPV for mucus impaction. There was a high degree of
interobserver agreement for MRI findings (k=0.9-1) as well as
agreement (k=0.7-1) between CT and MRI for all the four
findings.
Conclusions: With the currently available routine MR
sequences, MRI demonstrates high specificity but less
sensitivity and negative predictive value to HRCT scan in
children with ABPA. Newer MR sequences need to be explored
and validated to enhance the potential of lung MRI in ABPA.
Poster #: SCI-067
Diagnostic accuracy of ultrasound for identifying metastatic
cervical adenopathy in pediatric patients with differentiated
thyroid carcinoma at presentation
Mara Navallas Irujo, MD, [email protected];
Alan Daneman, Afsaneh Amirabadi, Jonathan Wasserman;
Hospital for Sick Children, Toronto, Ontario, Canada
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To evaluate the diagnostic accuracy
of US and the most useful sonographic features for diagnosing
metastatic cervical adenopathy in pediatric patients with thyroid
carcinoma
Methods & Materials: IRB-approved retrospective study in a
tertiary children's hospital. Eligiblity for inclusion were all
consecutive children with pathologically proven thyroid
carcinoma from 2008 to 2017. Patients with no preoperative US
or no resected lymph nodes were excluded. Pathology report of
lymphadenopathy was used as the gold standard. Size, shape,
echotexture and vascularity of the lymph nodes were analyzed
and compared to the pathology findings
Results: We reviewed preoperative US and histology reports of
resected lymph nodes in 52 children with proven thyroid
carcinoma (33F,19M; age range 5-18y; mean 13y). Metastatic
cervical lymph node disease was documented on US in 29
children and on histology in 33. Sensitivity of US was 79%,
specificity 84%, PPV 90%, NPV 70% and accuracy 81%. A
significant association was seen between round shape,
echotexture, vascularity and lymph node histology. The
measurements in short axis for the metastatic nodes was
significantly higher than benign nodes (U=168.5,P=0.005,
Mann-Whitney U test). No significant difference was noted
between the groups in long axis. Logistic regression Univariate
analysis showed that round shape (OR=0.054,95%CI=0.006–
0.466), echotexture (OR=0.048,95%CI=0.01-0.234), vascularity
(OR=0.025,95%CI=0.003–0.225) and short axis measurement
(OR=1.473,95%CI=1.019–2.130) contribute significantly to
make a positive diagnosis. Multiple logistic regression analysis
showed only vascularity contributed significantly to explain the
disease probability when adjusting for the other variables.
Importantly, 11 patients (38% of children with metastatic
disease documented on US) had US diagnosis of abnormal
lymph nodes based solely on abnormal echogenicity and
vascularity, with normal size and shape
Conclusions: Neck US showed high accuracy, sensitivity and
specificity for identifying malignant adenopathy in children
with thyroid carcinoma. Most of the abnormal lymph nodes
were round in shape and had abnormal echogenicity and
vascularity. However, this paper emphasizes that metastatic
nodes may be normal in size and shape and the abnormality may
be based solely on abnormal echogenicity and vascularity. Size,
particularly long axis measurement, is not a reliable criterion to
differentiate between malignant and benign lymph nodes. This
has not been reported previously in pediatrics
Poster #: SCI-068
Prospective Comparison of MRI and Enhanced MDCT for
Evaluation of Pediatric Pulmonary Hydatid Disease: Added
Diagnostic Value of MRI
Kushaljit S. Sodhi, MD, PhD, FICR1, [email protected];
Anmol Bhatia1, Joseph Mathew1, Ram Samujh1, Edward Lee,
MD, MPH2; 1Radiodiagnosis & Imaging, Pgimer,Chandigarh,
Chandigarh, India, 2Boston Children Hospital, Boston, MA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To prospectively investigate the
diagnostic accuracy and added value of lung MRI for evaluating
pulmonary hydatid disease in children by comparing MRI
findings with MDCT findings.
Methods & Materials: 28 consecutive children with clinically
suspected of having pulmonary hydatid disease were enrolled in
this prospective research study from October, 2012 to July,
2018. In all 28 pediatric patients (24 boys, 4 girls; mean age,
8.93 +/- 3.1 years; range, 5 to 17) were included in this study,
MRI without contrast and enhanced MDCT of the chest were
performed within 48 hours of each other. Two pediatric
radiologists independently evaluated the lungs for the presence
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S208
of consolidation, nodule, and mass (solid versus cyst). Cyst was
further evaluated for the presence of fluid, air, and internal
membrane. The accuracy of MRI and MDCT for detecting
pulmonary hydatid disease was obtained and compared between
them. Interobserver agreement was measured with the kappa
coefficient.
Results: Final diagnosis of pulmonary hydatid cyst was
established in 25 children. Post-surgical histopathological
confirmation was available in 12/25 patients (48%), while a
positive hydatid serology was confirmed in 8/25 patients (32%).
Remaining five patients (20%) were diagnosed to have
pulmonary hydatid cyst based on the epidemiological setting
and typical radiological findings. The accuracy of MRI and
MDCT for detecting pulmonary hydatid cyst was 92.86%.
There was no difference between MRI and MDCT for
accurately detecting pulmonary hydatid cyst (p < 0.001).
Internal membranes were detected in 11/28 patients (39.28%)
with MRI and 3/28 patients (10.71%) with MDCT. Almost
perfect interobserver agreement was present between two
independent reviewers (k = 1).
Conclusions: Lung MRI without contrast is comparable to
enhanced MDCT for accurately detecting lung cyst in pediatric
patients with pulmonary hydatid disease. However, MRI
provides an added diagnostic value by demonstrating internal
membranes which is specific to pulmonary hydatid disease.
Poster #: SCI-069
Combining chest radiographic findings and genomic scores
to improve assessment of disease severity in pediatric
community acquired pneumonia (CAP).
Julie C. O'Donovan, MD1,
[email protected]; Becky Murray,
MD1, Houchun Hu, PhD1, Rebecca Wallihan, MD2, Asuncion
Mejias, MD, PhD2, Octavio Ramilo, MD2, Rajesh
Krishnamurthy1; 1Department of Radiology, Nationwide
Children's Hospital, Columbus, OH, 2Division of Infectious
Disease, Nationwide Children's Hospital, Columbus, OH
Disclosures: Asuncion Mejias, MD, PhD: Consultant,
Honoraria & Research Grant: Janssen, CME Lectures: Abbvie.
Octavio Ramilo, MD: Consultant, Honoraria: Merck, Pfizer,
Sanofi, Janssen, Research Grants: Janssen. All other authors
have disclosed no financial interests, arrangements or
affiliations in the context of this activity.
Purpose or Case Report: CAP is a worldwide contributor to
morbidity and mortality in children. Radiogenomics is an
emerging specialty which correlates imaging features to gene
expression to predict disease severity, therapeutic response and
clinical outcomes. A genomic score termed Molecular Distance
to Health (MDTH) is a biomarker that measures the global
transcriptional perturbation in blood and has been shown to
correlate with disease severity in pediatric CAP (Wallihan R,
Front. Cell. Infect. Microbiol. 2018). This study was undertaken
to determine whether abnormalities on chest radiographs
correlate with genomic and clinical markers of disease severity.
Methods & Materials: Initial chest radiographs of children
(age 2 months - 18 years) admitted to a single institution
between February 1, 2011, and May 10, 2012 for CAP were
reviewed retrospectively. An experienced pediatric radiologist
blinded to the clinical data recorded abnormalities including
peribronchial thickening, adenopathy, pleural effusion, and
pulmonary opacities (characterized as band-like, streaky,
consolidative, round or other). Clinical and laboratory data were
collected including length of hospitalization (LOS), days of
respiratory support (DOS), days of fever (DOF), blood culture,
CBC, procalcitonin, C-reactive protein (CRP), and
nasopharyneal/oropharyngeal swabs for viral and bacterial
pathogen detection, and whole blood for transcriptional analysis
and MDTH calculation. We used chest radiographic findings to
classify patients according to clinical variables and the genomic
MDTH score. We performed two-tailed unpaired t-test to
compare groups stratified by radiological findings.
Results: 144 chest radiographs were reviewed. Patients with
pleural effusion (right or left) (n=43, 30%) showed significantly
longer LOS, DOS, DOF, CRP and higher MDTH scores (all p
<0.05) compared with those patients without pleural effusion
(n=101). Likewise, patients with consolidative opacity (air
space opacity) (n=82, 57%) showed significantly longer LOS,
DOF, and higher MDTH scores (all p <0.05) compared with
those patients without a consolidative opacity (n=62).
Conclusions: In a cohort of children hospitalized with CAP, we
identified chest radiographic findings that classified patients
according to: 1) clinical markers of disease severity and 2) the
MDTH genomic score. Combining radiographic and genomic
markers should contribute to a more precise clinical disease
severity classification in pediatric CAP.
CASE REPORT, EDUCATIONAL AND
SCIENTIFIC POSTERS -
TECHNOLOGISTS(T) indicates an Imaging Technologist Program Submission
Poster #: CR-001 (T)
SMA Syndrome: An Obscure but Clinically Relevant
Condition
Parker T. Stanley, MHA, BSRST1,
[email protected]; Charles T. Stanley, BSRT2; 1Ultrasound, VCU Health, Charlottesville, VA, 2Guerbet LLC,
Trenton, NJ
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Superior mesenteric artery (SMA)
syndrome, or Wilkie’s syndrome, is an obscure condition in
which an acute angulation between the aorta and SMA leads to
compression of the third part of the duodenum. Subsequently,
patients typically present with a constellation of gastrointestinal
findings that closely resemble small bowel obstruction, early
satiety, and anorexia. SMA syndrome is most often observed in
the setting of rapid weight loss, wasting conditions, and
corrective spinal surgeries, where a decrease in retroperitoneal
fat diminishes the cushion between the aorta and SMA, causing
vascular compression of the duodenum. Diagnosis of SMA
syndrome is one of exclusion and is based on the combination
of highly suspicious clinical findings and confirmatory
diagnostic imaging evidence of obstruction. Upper GI
Fluoroscopy can demonstrate a dilated first and second portion
of the duodenum, with compression of the third portion, and
delayed passage of contrast past midline. Ultrasound and
computed tomography (CT)/magnetic resonance imaging (MRI)
enable measurement of the aortomesenteric angle and distance,
with normal values ranging from 25-60° and 10-28mm,
respectively, and values indicative of SMA syndrome ranging
from 6-15° and 2-8mm, respectively.We present a classic case
of SMA syndrome in a 15-year-old patient. The patient
presented with clinical symptoms consisting of scoliosis,
chronic nausea and vomiting, weight loss, and anorexia. The
patient then underwent Upper GI Fluoroscopy which
demonstrated duodenal dilatation and delayed contrast transit
past midline, achieved only after prolonged decubitus and prone
positioning. Subsequently, abdominal ultrasound demonstrated
an aortomesenteric angle of 10-18° and an aortomesenteric
distance of 5 mm. Lastly, abdominal MRI demonstrated an
aortomesenteric angle of 15° and an aortomesenteric distance of
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S209
3 mm, corroborating the ultrasound findings and confirming the
diagnosis of SMA syndrome. The patient was initiated on
nutritional support and at most recent follow-up was responding
well to conservative treatments.
Conclusions: Knowledge of the imaging findings of this rare
disorder can provide early diagnostic capabilities and lead to
more effective treatment plans.
Poster #: CR-002 (T)
MRI Non-Contrast Images of the Great Vessels in Pediatric
Cardiac Patients
Audrey Bryant, Advanced Medical Imaging Technology,
[email protected]; Ali Kandil; MRI, Cincinnati
Children's Hospital, Ludlow, KY
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Gadolinium, a type of MRI contrast
is typically used when imaging pediatric cardiac patients.
Gadolinium enhances the images to give more clarity to the
radiologists when distinguishing normal tissue from abnormal
tissue. Further, contrast also allows for better visualization of
the great vessels.Gadolinium alters the magnetic properties of
nearby water molecules in the tissue. While contrast itself does
not alter the tissue composition, it does affect how the scanner
takes the picture. Accordingly, images can differ between pre-
and post-contrast administration. While IV contrast can be
administered safely, it is not without logistic implications and/or
risks.MRI contrast can be given to pediatric cardiac patients
intravenously, but IV access is oftentimes challenging in
pediatric cardiac patients. In an effort to reduce the number of
unsuccessful IV attempts and quantity of contrast administered,
a novel non-contrast MR sequences is being utilized to better
depict the great vessels in these children. If IV access is
unsucessful or the patient cannot complete the MRI, this
modality is employed to obtain more information on the
patient's cardiact vasculature.This purpose of this case report
paper is to show the MR imaging when using a non-contrast
sequence to identify cardiac vessels in pediatric patients who
cannot recieve IV contrast.
Poster #: CR-003 (T)
Scrotal Complication or Inflammation: Case Study of
Pediatric Epididymitis
Teela M. Durfee, AAS, [email protected]; Tara Cielma;
Ultrasound, Children's National Medical Center, Silver Spring,
MD
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Pediatric scrotal ultrasound
pathology can be difficult because of the similar presentation of
different pathology such as scrotal torsion, epididymitis,
inguinal hernia, epididymal appendix torsion, and trauma.
Identifying key factors of each condition is paramount to
providing a clear diagnostic picture in the setting of an atypical
presentation of any pathology.Epididymitis is an inflammatory
process precipitated by bacterial or viral infections. Symptoms
typically present as increasing scrotal pain with swelling of the
epididymis. Depending on degree of severity imaging
presentation can mimic other pathology.A 5 year old male
transferred to a pediatric facility from an area hospital to assess
suspected incarcerated hernia with outside CT and ultrasound
images.
Methods & Materials: Outside diagnostic imaging shows
complex, hyperemic mass-like structure in the superior aspect of
the right scrotal sac with surrounding edema and preserved flow
to both testicles.Outside CT exam, upon second read, shows an
enlarged, edematous right epididymis and small hydrocele with
overlying soft tissue thickening and stranding tissue extending
from the right scrotum through the inguinal canal. Examination
shows no evidence of hernia or incarceration.
Results: Additional diagnostic sonography imaging
demonstrated progression of inflammatory condition within the
right scrotal and inguinal area. The right epididymis presented
edematous, hyperemic, and heterogenous with surrounding soft
tissue edema and scrotal wall thickening. Flow to the right
testical was preserved however, the inflammation affected the
orientation of the right testical in the scrotal sac.
Conclusions: This case highlights the difficulty in clearly
identifying pathology for acute testicular pain in a pediatric
patient without known trauma.
Poster #: EDU-001 (T)
EDI: a friendly interactive tool to guide the pediatric health
professional in ordering the correct radiograph
Caroline Boileau, Medical Radiation Technologist1,
[email protected]; Lee Treanor, Medical Student (MS2)2,
Cassandra Kapoor1, Kerri Highmore, MD1, Elka Miller, MD1; 1Medical Imaging, CHEO, Ottawa, Ontario, Canada, 2University of Ottawa, Ottawa, Ontario, Canada
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Imaging requisitions are the legal
documents that health professionals use to communicate to
radiologists and Medical Radiation Technologists (MRT(R)s)
the relevant clinical information to guide their requested
radiographic examination. Inadequate or incomplete
information may have a substantial impact on patient care.Since
the implementation of our electronic medical record system,
EPIC (Epic Systems Corp.), we have the ability to track the
number of errors on requisitions; the most common error is
having the incorrect body parts selected or multiple unnecessary
exams being ordered. The MRT(R)’s identify these errors and
correct the inconsistencies following departmental protocols.
Without such vigilance on the MRT(R)’s part, inappropriate
radiographs could have been performed and could lead to
additional, unnecessary radiation exposure. To help select the
most appropriate protocol, educate and guide the health
professionals at our hospital, an electronic software tool, “EDI”
has been created.EDI (Examine the patient, Determine the
correct radiograph, Input the order with pertinent and relevant
clinical information) is an interactive tool that includes the exam
protocol with the associated views per body part. Each exam
also includes EDI with the field of view that will be exposed to
radiation during the exam.Our goal is that EDI will serve health
professionals to better understand what order needs to be
selected in the electronic system and which radiographs will be
provided. Ultimately, this will reduce any unnecessary exams
and reduce pediatric radiation exposure.
Poster #: EDU-002 (T)
Non-contrast MRA to decrease gadolinium-based contrast
agent administration in children and young adults
Kathleen A. Rendon, A.A.S., [email protected];
Cynthia K. Rigsby, MD; Medical Imaging , Ann and Robert H.
Lurie Chidlren's Hopsital of Chicago, Chicago, IL
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S210
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Purpose: The long-term effects from
gadolinium tissue deposition in organs and the brain is unknown
especially in children who may need repeated contrast studies
for necessary follow-up of cardiovascular abnormalities. We
aim to show the utility of a non-contrast MRA sequence in older
children and young adults undergoing chest and/or abdominal
MRA.
Methods & Materials: Methods: We retrospectively review the
utility of non-contrast navigator-triggered and ECG-gated 3D
steady-state free precession (SSFP) imaging of the chest and
abdomen generally acquired in the coronal plane performed for
evaluation of cardiovascular abnormalities.
Results: Results: When acquired during diastole to limit the
amount of turbulent flow, non-contrast 3D SSFP imaging is
successful in all patients who are able to remain still with
regular breathing rates. The studies are diagnostic in over 90%
of all older children and young adults with non-diagnostic
imaging only occurring when there is substantial flow
turbulence related to vascular or valve stenosis. The pulmonary
veins are also occasionally not well visualized. There can be
substantial artifact in younger children. A contrast-enhanced
study should be performed following a non-diagnostic non-
contrast study which will occur in a small percentage of older
children and young adult patients.
Conclusions: Conclusions: Gadolinium based contrast can be
eliminated for most chest and abdomen MRA studies in older
children and young adults.
Poster #: EDU-003 (T)
Bowel Sonography: Technical approach and challenging
diagnoses
Tara Cielma1, [email protected]; Teela Durfee1, Dorothy
Bulas, MD1, Judyta Loomis, MD1, Adebunmi Adeyiga2, Anjum
Bandarkar2; 1Children's National Medical Center, Washington,
DC, 2Mid-Atlantic Permanente Medical Group, Rockville, MD
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Bowel ultrasound is a critical
component of gastrointestinal evaluation. Serial examination
allows real-time assessment of disease progression or
improvement, and assists the clinician in therapeutic decision
making and clinical management.The goals of this exhibit are:1.
Describe the technical approach of performing bowel
ultrasound.2. Review tips, and up to date technology that assist
in optimizing studies.3. Discuss sonographic appearance of
various pathologies.4. Review future potential techniques and
applications including utility of Doppler flow and contrast
enhanced ultrasound.
Methods & Materials: Bowel ultrasound studies at our institute
were reviewed retrospectively with selected representative cases
chosen to illustrate technical aspects and clinical indications for
this procedure. Correlation was made with follow up radiology
studies, clinical and/or surgical outcomes.Necrotizing
enterocolitis, inflammatory bowel disease, infectious colitis,
neutropenic enterocolitis, malrotation, short bowel syndrome,
appendicitis, intussusception, Meckel's diverticulitis, intestinal
polyp, vascular malformations, graft versus host disease,
intestinal hemorrhage, perforation, and obstruction will be
discussed.
Results: Typical findings in normal and abnormal pediatric
bowel exams will be illustrated. Emphasis on appropriate
technique and methodology for serial examinations will be
described.
Conclusions: Through this exhibit, participants will learn to
utilize bowel ultrasound as a powerful tool in evaluating
pediatric gastrointestinal diseases and understand how to
optimize their technique.
Poster #: EDU-004 (T)
Abdominal distention in a Newborn: Is it NEC?
Libby Schneeman, [email protected]; Asef Khwaja,
MD, Glenn Bloom, AS, RDMS, Hansel J. Otero, MD;
Children’s Hospital of Philadelphia, Clayton, NJ
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Ultrasound has become a powerful
tool for the evaluation of bowel pathology in the children. In the
newborn, ultrasound (US) can be used to diagnose, stage, and
follow up necrotizing enterocolitis (NEC) and its complication.
US has excellent sensitivity and specificity for the identification
of bowel wall thickening, peristalsis, pneumatosis, portal
venous gas and free air and has become an integral evaluation
tool for the newborn with abdominal distention. Our educational
poster will:1. Summarize proper US equipment, technique and
protocol for diagnosing and following up NEC2. Discuss
advantages and benefits of incorporating US in the evaluation of
bowel in newborns3. Illustrate the sonographic findings of mild,
moderate and severe NEC through cases
Methods & Materials: Pictorial review of US findings of NEC
including grayscale and color Doppler. Comparison is made to
similar findings in radiographs and clinical correlation.
Results: The spectrum of normal and abnormal neonatal bowel
US findings are presented. Abnormal findings are presented
using illustrative cases.
Conclusions: Ultrasound is a powerful tool that supplements
and at times can replaced more traditional diagnostic methods in
the assessment of NEC. This educational exhibit provides a
practical guide for systematic evaluation of bowel in the
newborn and how to diagnose, stage and follow up NEC and its
complications.
Poster #: EDU-005 (T)
Reliable Projectile Hazard Reduction in MRI
Katherine Bushur, BSRS RT(R)(MR), MRSO (MRSC™),
[email protected]; MRI, Children’s
Hospital Colorado, Aurora, CO
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: In 2016, we focused on MRI safety
and the inherent cultural barriers to reduce the risk of
undetected or misplaced metal objects causing MRI accidents.
We successfully addressed this opportunity using a coordinated
approach with Patient Safety, Performance Improvement and
Radiology Leadership to provide a multi-faceted
solution.Despite implementation of ferromagnetic detection
systems (FMDS) technology, numerous gaps in screening
effectiveness were identified. Three primary improvement
objectives were established involving place, people and process
leading to 42 new practice changes that were implemented, and
68 existing process improvements instituted. Alarm fatigue was
one among many identified risks. Variables included the
physical location of the projectile on the transport person, as
well as the horizontal or vertical orientation of potential hazard
while being carried were identified during a series of nine
standardized PDSA testing sessions that were completed in the
clinical setting.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S211
Methods & Materials: A series of ten standardized PDSA
testing sessions were completed in the clinical setting and
included the use of a pre-screened ferrous-free person who
transported a “control” projectile through the FMDS at separate
intervals. The control consisted of either a 4.5” straight scissors
or a 5” curved forceps divided into two groups; exposed and
non-exposed. All controls were deemed a “projectile hazard”,
according to the ASTM deflection test (Ref).
Results: Significant gaps in effectiveness and programmatic
variables were identified within the expected performance of the
FMDS installed. With the current settings and modifications
made, we discovered a gap that exists at the center region of
each door passageway where detection was minimal.Through
our project, 42 new practice changes were implemented and 68
existing process improvements were achieved. A 78% reduction
in alarm rates was achieved and a 100% reduction of incidents
where hazardous projectiles entered zone IV was realized.
These reductions were achieved via optimization and
customization of the latest FMDS technology and various
process changes and improvements.
Conclusions: Institutions where these devices have been
installed may not be able to reliably detect metallic objects
classified as projectile hazards. Validation of installed systems
can and should be accomplished in order to optimize the level of
sensitivity and effectiveness of each FMDS installed in situ.
Poster #: EDU-006 (T): Withdrawn
Poster #: EDU-007 (T)
Challenges of Pediatric DEXA
Melissa Goehner, [email protected]; Mary E.
Anderson, Associates of Applied Science, Monica C. Pinson,
B.S, CNMT, Stephen Simoneaux; Diagnostic Radiology,
Children's Healthcare of Atlanta, Stone Mountain, GA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To describe and discuss some of the
challenges of performing DEXA scans on pediatric patients
including positioning, technical obstacles, reference data and
post-processing and describing how to overcome some of these
challenges.1. Positioning: Many patients with syndromes, have
scoliosis, para or quadriplegia, or contractures that make placing
the patient on the table difficult. In these patients, imaging has
to be adapted to the patients’ abilities and some components
may need to be eliminated. With cerebral palsy and muscular
dystrophy for example, the whole body and AP spine might
have to be deferred and only a hip and forearm obtained.2.
Technical obstacles: There are many technical obstacles that can
present challenges when performing DEXA scans on pediatric
patients. Patients who have prostheses or metal rods present
technical obstacles. There is no way to remove the metal
artifacts in a whole body scan on these patients, so a hip or
forearm might be the most accurate way to obtain the patient’s
bone density due to this technical factor.3. Reference Data: The
reference data for pediatrics is limited in national data bases.
For example, a total Z-score will not be factored for children
under the age of 5 because there is not enough information in
the national database for comparison. There is also not enough
information on children of certain ethnicities. This presents a
problem when diagnosing and treating children with abnormal
bone density.4. Post-processing could be different for each user.
It can also be different for machines manufactured by different
companies. For example, a machine made by Hologic might
produce different numbers than a machine made by General
Electric. Also, if the user does not place the post-processing
tools the exact same way the prior user did, the results can
vary.Overcoming some of these challenges has presented
opportunities to grow. Sedation is used for children who may
not be able to be perfectly still for a Dexa and positioning tools
help on some of the more challenging patients. Learning how to
work around prostheses and working with the ordering
physicians and radiologists with the limited amount of reference
data are a few ways of growing from these challenges.
Placement of post-processing tools are the key to providing key
information in comparing Dexa scans for patients who have
them regularly for evaluations. Staff Education is the largest
challenge to overcome.
Poster #: EDU-008 (T)
Optimization of PET/MR Scan Protocol With Introduction
of a 3D T2 Dixon Sequence
Elad Nevo, MS, RT(MR)(N)(CT), CNMT,
[email protected]; Lisa States, Ralph Magee,
RT(R)(MR)(CT); Children's Hospital of Philadelphia,
Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: PET/MRI is a relatively new imaging
modality whose efficacy is still being determined. One of the
major draws to PET/MR over PET/CT is the reduction in
radiation exposure to patients. This is especially desirable in the
pediatric population due to the likelihood of multiple exposures
during their lifetime, and the increased sensitivity they have to
radiation. A typical whole body PET/CT exam can take about
30 minutes, whereas a typical whole body PET/MR exam takes
about 90 minutes at our institution. The introduction of a new
3D T2 Dixon technique sequence for PET/MR has the potential
of decreasing total scan time significantly, however maintaining
current image quality and diagnostic value is critical. Our
objective is to test out this new sequence to see whether scan
times are reduced and if it is a viable diagnostic replacement for
our current T2 sequence.
Poster #: EDU-009 (T)
Discussion over speed stitching in the pediatric world
Amal Baida, [email protected]; Stephen Simoneaux;
Children's Healthcare of Atlanta, Duluth, GA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: The purpose of this study is to
outline the benefit of speed stitching and recognize it as one of
the best stitching tools available for the pediatric population.
Looking at the history of stitching, we started by using the CR
for scoliosis and long bones stitching. The time of exposure, the
radiation dose, and image quality were not optimal. Moving to
automatic DR stitching was a good step in the right direction.
However, there was still a frustration from having to repeat so
many exams because of the high possibility of motion captured
between exporsures. That’s when speed stich came to play with
fast acquisation and less operator interference while doing the
exam.
Methods & Materials: Recognizing the challenges of doing
scoliosis or long film stitching in the pediatric world led us to
start this conversation. Motion and exposure factors were big
topics.CR’s low bone resolution has been posing a challenge
with the risk of overexposure; DR’s auto stitching brought the
fast image acquisition with better quality and high volume
capacity, still posing some issues with manual stitching and the
overlap of vertebras. Discussions were conducted on several
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S212
scoliosis and example cases were identified. Most importantly,
the accuracy of the images for optimum diagnosis was our
priority at CHOA. Speed stitching was identified as a solution
for many of the inefficiencies in other technologies. With Speed
stitching, we were able to reduce a scoliosis exam from 15
minutes to about 4 minutes with lower radiation and better
quality.
Results: A case- based education for speed stitch vs other ways
of stitching was developed and comparison cases with other
methods of stitching were demonstrating for comparison and
contrast. Reviews by the radiologists determine the advantages
of speed stich and full transition to that technology is in process
for the whole system at CHOA.
Conclusions: Beside the higher initial cost, using speed stitch
was faster. It demonstrated better image quality, less dose and
better accuracy.Technologists moving from CR/DR to speed
stitch had no challenges or issues learning the new technology.
Mostly everyone thought it was more efficient and easier to use.
Poster #: EDU-010 (T)
An Imaging Technologist's Guide to Artificial Intelligence
Parker T. Stanley, MHA, BSRST1, Charles T. Stanley,
BSRT2, [email protected]; 1Ultrasound, VCU Health,
Charlottesville, VA, 2Guerbet LLC, Trenton, NJ
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: In 2017, roughly 2 trillion
(2,000,000,000,000) medical images were produced, reviewed,
reported, archived, and used in the detection and management of
disease. Based on historical trends, this number has doubled
every 5 years and is accelerating. This explosive growth in
imaging data has created major opportunities for the use of
Artificial Intelligence (AI). The question is less whether
radiologists, and technologists, will be replaced by AI (they will
not) and more about whether we could survive without AI.
Although intelligent algorithms have been used for some time in
segments of the imaging field, new methods of machine
learning, based particularly on “deep learning”, are much more
powerful. Many of the deep learning publications today point to
the promise of significant advances in efficiency, precision,
reproducibility, and prognostic abilities.If AI will not replace
radiologists/technologists but rather augment them with tools to
meet the rising demands for diagnostic imaging, then it is
imperative that we have a basic understanding of the concepts
and language that defines this area of knowledge. In the not so
distant past the average technologist understood the basics of
film processing but wouldn’t even recognize the words DICOM
or EMR; we are now at that point of change with AI. Deep
learning, machine learning, neural networks, ground truth, the
list goes on. The goal of this presentation is to provide a basic
framework of the concepts, terminology, and references to how
AI has, and likely, will be employed in medical imaging, thus
making us better practitioners and partners with this
technology.
Poster #: EDU-011 (T)
What is a Pediatric Trigger Thumb?
Falguni Patel, Associates,[email protected]; Medical
Imaging (Ultrasound), Lurie Children's Hospital of Chicago,
Chicago, IL
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: My purpose is to teach my audience
about a congenital condition called Pediatric Trigger Thumb.
My educational poster will include anatomy, causes, and
symptoms associated with Trigger thumb and a pediatric
ultrasound case that relate with a finding of Trigger thumb.
Methods & Materials: 3 years old girl presented as an
outpatient with a history of bump or nodule to the base of her
Left thumb for about a year. The ultrasound of left thumb was
order to rule out the nodule and any structure anomaly.
Results: Musculoskeletal ultrasound of the left thumb was
performed using Musculoskeletal (MSK) superficial setting.
The series of longitudinal and transverse images were
documented of the nodule area. Based on the sonographic
evaluation of the palmar base of the left thumb demonstrated a
well-defined ovoid predominantly hypoechoic lesion superficial
to the flexor pollicis longus tendon (FPL). The lesion measures
6x1x5mm without vascularity on the color Doppler ultrasound.
It did not exert mass effect on the underlying tendon but
definitely demonstrated A1 pulley thickening. Dynamic
scanning during passive flexion and extension showed difficult
tendon gliding underneath the abnormal A1 pulley. This may
represent the condition called Pediatric Trigger thumb.
Conclusions: In conclusion, Ultrasound should be an initial
imaging study of choice for condition such as pediatric trigger
thumb. Ultrasound can show varying degrees of flexor pollicis
longus(FPL) tendinosis with a distinct nodule, A1 pulley
thickening, and tenosynovitis. With ultrasound dynamic
scanning is so beneficial to rule our Trigger thumb. Even color
Doppler ultrasound plays a huge role in evaluating hyper
vascularity in the region of the pulley and surrounding soft
tissues. Thus, Ultrasound plays an important role in diagnosis
congenital condition such as Pediatric Trigger thumb.
Poster #: EDU-012 (T)
Importance of medical imaging and radiographic findings in
skeletal manifestations of Langerhans Cell Histiocytosis
Ewelina Ulikowska,[email protected]; Medical
Imaging, Ann and Robert Lurie Childresn Hospital , Des
Plaines, IL
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Langerhans Cell
Histiocytosis (LCH), is a disorder that primarily affects
children, but can affect individuals of all ages. Langerhans cells
are cells that are responsible for regulating immune system in
our bodies. They are mostly found in the skin, spleen, lymph
nodes, liver and bone marrow. In patients who have LCH, these
cells grow and multiply excessively. The abnormal growth of
the Langerhans cells causes a formation of tumors called
granulomas. LCH can affect different areas of the body: skin,
nails, lymph nodes, gastrointestinal tract, central nervous
system, pituitary and thyroid gland, liver, lungs and bones. The
severity and symptoms of the disease vary in individual patients
and are dependent on the organs and systems affected.
Oftentimes, LCH can be found in multiple areas of the body and
when that happens, the disease becomes a multisystem disease.
The most common system affected by LCH, seen in about 80 %
of individuals affected, is the skeletal system. Granulomas,
which develop most commonly in the flat bones such as skull
and long bones of arms and legs, cause sclerotic and lytic
lesions that can in turn become the cause of pathologic
fractures. Therefore it is crucial, to recognize the radiographic
signs of skeletal manifestations of LCH. Radiography is the
preliminary imaging of choice and skeletal surveys are
oftentimes the best assessment of the status of LCH prior and
post treatment. The purpose of this abstract is to describe
radiographic appearances associated with Langerhans Cell
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S213
Histiocytosis. In order to confirm the importance of follow up
skeletal surveys, I will present cases and associated radiographs
that show signs of LCH prior to treatment and post treatment.
Poster #: EDU-013 (T)
Imaging Juvenile Idiopathic Arthritis with Ultrasound
Parker T. Stanley, MHA, BSRST1,
[email protected]; Erika Rubesova, MD2; 1Virginia
Commonwealth University Health, Charlottesville, VA, 2Lucile
Packard Children's Hospital, Palo Alto, CA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Introduction: Juvenile Idiopathic
Arthritis (JIA) is the most common rheumatic entity in children
and the second most common cause of musculoskeletal
symptoms in pediatric patients. Treatment of JIA largely
depends on frequently managing inflammation within the joints,
and as such, ultrasound is a prime imaging modality that can be
used for detection and monitoring of inflammation. Ultrasound
is more sensitive than plain films in the early detection of JIA,
and ultrasound is more sensitive than clinical examinations
alone. As a low-cost, high-resolution imaging modality,
ultrasound allows visualization of the joint spaces, can be used
to detect joint effusions, and can monitor synovial proliferation
and joint hyperemia, all while not exposing the patient to
radiation. We will present ultrasound images of various joints in
children such as knees, ankles, wrists, hands and feet.
Ultrasound technique, imaging planes, choice of probes
frequencies and ultrasound settings are analyzed for
optimization of the images. This presentation will highlight the
diagnostic imaging findings of JIA on ultrasound, such the
presence of joint effusions, synovial proliferation, capsular
thickening, tendinitis as well as provide information on common
pitfalls associated with age-specific appearances of pediatric
musculoskeletal structures on ultrasound. Familiarity with JIA
and musculoskeletal ultrasound findings will allow timely
diagnosis and implementation of appropriate treatment
strategies.
Poster #: EDU-014 (T)
Ultrasound Utilization to Measure Spinal Lengthening with
Magnetic Expansion Control (MAGEC System)
Allison Lombardi, Associates,[email protected];
Children's Hospital of Philadelphia, Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: The MAGEC System is a surgical
treatment for children with severe spinal deformities. The
system utilizes surgically implanted rods, which are periodically
extended by an External Remote Control (ERC). The traditional
method to measure lengthening progression involved radiation
exposure. Ultrasound provides an immediate evaluation with no
bio-effects. Additionally, soft tissue changes incurred by rod
implantation can be seen, which is difficult to assess with a
radiograph. The sonographer acquires both pre- and post-
lengthening measurements before and after the ERC is applied
to the child’s skin at the level of the rods. The entire process can
be completed in minutes within a single outpatient room, for the
ease of both patient and parent.
Methods & Materials: Children with scoliosis too severe for
bracing or casting and too young for spinal fusion, have been
traditionally managed with growing rods. This involves
repeated surgical elongation, often requiring ten or more
surgeries before the child reaches skeletal maturity.MAGEC
rods require initial implantation surgery and are expanded with
the use of an externally applied ERC. The sonographer scans
each rod, measuring the pre-lengthening measurement. The
physician utilizes the ERC to externally manipulate the
MAGEC rods. The sonographer scans the child again, and can
determine if the rods have been sufficiently extended.
Additional ERC applications, if necessary, can then be
employed.
Results: Ultrasound has proven to be a useful tool in the
measurement of MAGEC rod extension in patients with severe
spinal deformities. It can easily be performed within the
examination room in conjunction with the application of the
ERC.
Conclusions: The use of ultrasound to measure the lengthening
of MAGEC rods minimizes radiation exposure, decreases the
need for repeated surgeries, and allows for soft tissue
evaluation. It streamlines the process of obtaining
measurements and can be utilized in one room within an
outpatient setting, simplifying the encounter for patient and
family.
Poster #: EDU-015 (T)
Dynamic Sonographic Evaluation of the Glenohumeral
Joint in Children with Brachial Plexus Birth Injury (BPBI)
– A Practical Approach
Marcy L. Hutchinson, AS1, [email protected];
Brandi Kozak, BSDI1, Victor Ho-Fung, MD1, Nancy Chauvin,
MD2; 1Children's Hospital of Philadelphia, Philadelphia,
PA, 2Penn State Hersey Radiology, Hersey, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Background:Sonographic
techniques are simple and safe. The utility and clinical value of
dynamic sonographic evaluation of the glenohumeral joint in
infants with brachial plexus injury (BPBI) has been described
since the late 1990's. However, this technique remains an
underutilized tool in most imaging practices. Brachial plexus
injury during the birthing process can lead to glenoid dysplasia,
posterior shoulder subluxation and significant morbidity if left
untreated. Imaging evaluation of the degree of deformity is
paramount to guide clinical treatment and the follow-up of
complicated cases. Imaging techniques include MRI, CT and
US. Shoulder ultrasound provides a dynamic, noninvasive
method of evaluation. It has also been our experience that this
imaging technique can be mastered by the Sonographer and
supported with accurate interpretation by the
Radiologist.Purpose:Describe the imaging features of
glenohumeral joint dysplasia due to BPBI with emphasis on
ultrasound technique.Review step-by-step dynamic sonographic
evaluation of the glenohumeral joint in BPBI with emphasis on
correct positioning of the patient to ensure consistency and
reproducible quality imaging.Improve both confidence and
independent evaluation of patients through this presentation by
the sonographer.
Methods & Materials: Proper technique will be demonstrated
utilizing multiplanar dynamic imaging techniques performed
with high frequency linear transducers. Tips for proper patient
positioning in the abducted and adducted shoulder positions will
be included. The normal glenohumeral joint anatomy will be
shown as well as cases of varying degrees of shoulder dysplasia.
Results: Knowledge of proper patient positioning and imaging
planes is crucial in order to accurately evaluate for pathology.
With proper technique, ultrasound can evaluate the severity of
shoulder dysplasia and help guide treatment.
Conclusions: Dynamic ultrasound can be used successfully to
evaluate the infant shoulder for evaluation of BPBI. The
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S214
techniques can be mastered by a sonographer and radiologist in
the setting of clear concise practical techniques, resulting in
broader scopes of practice.
Poster #: EDU-016 (T)
Imaging of Pediatric Airways: You Might Get Winded,
Take a Deep Breath First
Kathleen Ksiazek, Bachelor's of Science
[email protected]; Medical Imaging, Ann & Robert
H. Lurie Children's Hospital of Chicago, Chicago, IL
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Medical imaging of the soft tissue of
the neck or airway is one of the most common, and sometimes
challenging, exams performed at a pediatric hospital. Imaging
of the airway can help identify enlarged adenoids, the presence
of a foreign body, an abscess, pathology or anatomical
abnormality. It is crucial to understand the proper technique,
breathing instructions and positioning in order to obtain optimal
imaging for correct diagnosis. Different radiographic findings
will be presented with examples of incorrect positioning, grid
usage, exposure factors, artifacts and ways to improve the image
quality. This poster will also provide technologists with tips and
recommendations to help them to feel prepared and confident to
work with all pediatric patients.
Poster #: EDU-017 (T)
DXA! DXA!! Read All About It!!!
Sara Turner, Associates of Applied Science, Radiolography,
[email protected]; Radiology, Children's
National Medical Center, Frederick, MD
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: The goal of this presentation is to
provide a review of the important role Dual Energy X-ray
Absorptiometry (DXA) plays in treating pediatric patients with
low bone density. It also aims to educate on the different DXA
machines used today, give a review of the official positions for
pediatric DXA scans determined by the International Society for
Clinical Densitometry (ISCD), give a brief history of the lateral
distal femur (LDF) scan and why it was developed, and touch
on the other modalities that can be used to asses bone
density..Osteoporosis is commonly thought of as an adult bone
health issue; however recently it has gained more attention as
being an issue for pediatric patients. Different factors affect
bone health, such as genetics and family history, diet and
exercise, certain medications, and whether a patient is
ambulatory or non-ambulatory. It is important to conduct the
proper testing to determine a patient’s fracture risk and trying to
prevent further bone deterioration. A DXA Scan is the gold
standard across all age groups in providing vital bone health
information as it provides a look into the body with minimal
radiation exposure to evaluate the bones to determine how much
at risk a patient may be.
Methods & Materials: We will look at examples of properly
positioned scans and what the results can look like. We will also
look at the difference between ambulatory and non-ambulatory
lateral distal femurs scans and compare the Z-Scores of those
scans.
Poster #: EDU-018 (T)
Transcranial Doppler – How to successfully perform an
optimal TCD on our younger patient demographic (ages 2-5
years)
Brandi Kozak, BSDI,[email protected]; Ultrasound,
Children's Hospital of Philadelphia, Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Transcranial Doppler examinations
are crucial in the care and treatment of patients in the Sickle cell
population. The earlier we are able to obtain diagnostic studies
on these patients the more effective treatment is and can reduce
the risk of the patient suffering from a life altering stroke.
Methods & Materials: This procedure while not invasive can
be very frightening for a younger patient. We employ several
different techniques and distractions tools to help the patient
cope soundly through the exam. We work closely with the
Hematology department staff and have developed a TCD task
force specifically focused for this age group to increase our
success rate. Some of the strategies we employ are as follows:
arranging the ultrasound room so that the patient is able to view
the television to watch a favorite show or program, letting the
child play games on smart phones or tablets (without too much
patient movement), having a parent or guardian lying with or
holding the patient, sitting the patient up slightly, blowing
bubbles, singing, having hand held musical or light up toys
available and/or arranging to have a child life specialist present
for the duration of the exam to help distract the patient. We have
also produced a short informational video for new patients to
view prior to coming to their first TCD exam so they can see
what to expect.
Results: By having several options in place and available, by
planning ahead and having resilient, dedicated sonographers we
are able to successfully perform TCDs on younger and younger
patients thereby facilitating more positive outcomes for this
patient population.
Conclusions: Transcranial Doppler ultrasound is a low cost,
easy to perform with dedicated practice, portable, radiation-free
modality that with set parameters in place can be extremely
successful in imaging younger patients. This exam gives
immediate, important information to the Hematologist that will
improve long term outcomes in the Sickle cell population.
Poster #: EDU-019 (T)
Pediatric Considerations for Y-90 TARE
Joseph MacLean, MHA, CNMT,
[email protected]; Nuclear Medicine, Cincinnati
Children's Hospital Medical Center, Cincinnati, OH
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To communicate important
information to technologists about the challenges associated
with performing Y-90 transarterial radio embolization (TARE)
therapy on pediatric patients. This “how to” poster will include
discussion of: coordination of services, pre-treatment Tc-99m
MAA mapping, preparing the dose calibrator for accurate
measurement of Y-90 activity, ideal hot lab set-up for dose
preparation, and imaging options for post Y-90 therapy
scanning.
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S215
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Pediatr Radiol (2019) 49 (Suppl 1):S1–S245
Poster #: SCI-001 (T)
Analyzing the Effects of Giraffe Beds on Radiation Dose
during Neonatal Digital Radiography
Jesse Green, [email protected]; Nikki Butler, BMSc,
RT(R)(QM), Kimberly M. Riegert, BS, Stephen Simoneaux;
Children's Healthcare of Atlanta, Atlanta, GA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: To compare the radiation doses that
result from different digital radiography imaging methods on
neonatal patients in Giraffe Beds using phantom imaging and
radiation measurement devices. The lowest dose options will be
considered to design an imaging process.
Methods & Materials: Using technical factors of 0.63 mAs and
60 kVp as a constant, test images were taken on a phantom in a
Giraffe Bed using the following methods:1) Cassette placed in
the bed tray and image taken with the hood down at 40” SID
(Source-to-Image Distance)2) Cassette placed directly under
phantom on bed mattress (not in tray) and image taken with the
hood down at 40” SID3) Cassette placed in the bed tray and
image taken with the hood up at 36.5” SID4) Cassette placed
directly under phantom on bed mattress (not in tray) and image
taken with the hood up at 32” SID5) Cassette placed directly
under phantom on bed mattress (not in tray) and image taken
with the hood down at 32” SIDFor each imaging method, the
radiation dose and EI (Exposure Index) number were recorded.
Results: The range of radiation dose recorded was 2.045-4.163
mR. The range of EI numbers collected was 78-318. The results
of the above methods are as follows:1. 2.045 mR, 78 EI2) 2.146
mR, 121 EI; 2.153 mR, 122 EI3) 3.874 mR, 99 mR; 3.941 mR,
101 EI4) 4.107 mR, 192 EI; 4.163 mR, 1915) 3.629 mR, 318
EIThe radiolucent bed hood caused a decrease of approximately
13% of the radiation reaching the image detector. Utilizing the
imaging tray in the Giraffe Bed caused a decrease of
approximately 5% of the radiation reaching the image detector.
Images taken at the shortest SID resulted in the highest doses
and least optimal EI numbers as anticipated. Please note Image
1 had an inconsistant EI measurement.
Conclusions: During the study, varying the SID had the most
significant impact on radiation doses and EI numbers compared
to the other factors caused by the Giraffe Bed. The maximum
SID allowed when the bed hood is raised is only 32” which
produces higher radiation doses and EI numbers compared to
imaging through the bed hood in the down position at a greater
SID. When designing an imaging process, the primary
consideration should compensate for a greater SID to reduce the
radiation dose and EI number. Imaging at a greater SID also
allows the technologist to select a wider range of technical
factors and avoid over exposure of the smallest neonatal
patients.
Poster #: SCI-002 (T)
Anesthesiology Challenges in MRI
Chris Harris, RT1, [email protected]; Elizabeth
Drum2; 1Radiology, Childrens National Medical Center,
Philadelphia, PA, 2Children’s Hospital of Philadelphia,
Philadelphia, PA
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity.
Purpose or Case Report: Anesthesiologists face challenges in
practicing in locations outside of the operating room. In
particular when working in the MRI environment there may be
unfamiliarity of the physiologic monitors and other equipment,
MRI safety policies and procedures, limited access to expected
equipment or additional anesthesia providers, unsure imaging
protocols and positions as well as inability to rescue patients in
the MRI scanner room.
Methods & Materials: Radiology must also understand how
lengthy or unpredictable imaging times, positioning, and
monitoring and equipment issues challenges anesthesia
providers as they care for patients in the MR
environment.Therefore anesthesiology and radiology must
recognize possible risk factors while caring for patients in MRI
and they must familiarize themselves with policies and
procedures of both departments to ensure safe practice for the
anesthetized children.
Results: To understand the risk of both anesthetizing patients
and the risk MR safety, radiology and anesthesiology must
partner to form a structure where anesthesiology, radiology and
nursing collaborate to ensure that the needs for patient safety
and the needs of MRI are met but ensuing that the priorities are
first to the patient, next to the enterprise and third to the
individual departments and division in order to provide the
safest environment for our patients.The structure has two
committees:Radiology, Anesthesia and Sedation (RAS)
Committee and is an active working group to improve patient
care and flow with ongoing initiatives that utilize appropriate
metrics to measure improvement. Issues that cannot be solved in
committee are escalated to the Operational Governance
Oversight Committee.Operational Governance Oversight
Committee (meets quarterly): Provides oversight to ensure
that the needs of all constituents are considered and met to the
best degree possible. Overriding priorities are first to the patient,
next to the enterprise, and third to the individual departments
and divisionsChairs from Anesthesiology, Pediatrics,
Radiology, Chief Operating Officer, Chief Nursing Officer
Conclusions: The MRI environment can be challenging to
anesthesiologists as they care for patients outside of their usual
environment. Collaboration between both radiology and
anesthesiology can improve the experience and safety of
anesthetized patient during MRI exams.
S216
2019 AUTHOR INDEX BY ABSTRACT
A
Abadeh, Armin Paper 087
Abbasian, Niekoo Poster EDU-023
Abbey, Craig K. Paper 072
Abid, Waqas Poster EDU-066
Poster EDU-071
Aboagye, Rosemond N. Poster EDU-052
Poster SCI-063
Abu-El-Haija, Maisam Paper 005
Paper 006
Acord, Michael Paper 014
Poster EDU-047
Poster SCI-037
Adeyiga, Adebunmi Poster EDU-003 (T)
Adler, Brent Paper 059
Paper 113
Poster SCI-046
Adzick, N. Scott Paper 096
Afacan, Onur Paper 026
Agahigian, Donna Paper 100
Agarwal Ritesh Poster SCI-066
Aggarwal, Varun Paper 038
Agnew, Amanda Paper 113
Ahrens-Nicklas, Rebecca Poster EDU-057
Alazraki, Adina Poster CR-013
Albertson, Megan Poster EDU-063
Algarni, Musleh Paper 130
Alhashmi, Ghufran Paper 155
Alian, Ali Poster EDU-095
Aljallad, Mohammed H. Poster SCI-001
Allain, Dominic Poster SCI-024
Allbery, Sandra M. Paper 145
Allen, Abigail Paper 067
Allen, Dana Paper 008 (T)
Alley, Marcus Paper 121
Paper 122
Paper 123
Paper 135
Al-Samarraie, Mohannad Poster EDU-009
Alves, Cesar Augusto Paper 134
Alves, Timothy Poster EDU-022
Amaral, Joao Poster SCI-033
Amirabadi, Afsaneh Paper 012
Paper 137
Poster SCI-065
Poster SCI-067
Anderson, Mary E. Poster EDU-007 (T)
Andronikou, Savvas Poster EDU-018
Poster EDU-025
Poster EDU-044
Poster SCI-022
Poster SCI-053
Annapragada, Ananth Paper 061
Paper 062
Paper 063
Paper 083
Paper 110
Anton, Christopher G. Alt 003
Paper 084
Anupindi, Sudha Poster EDU-033
Poster SCI-022
Aoki, Hidekazu Poster SCI-012
Aquino, Michael R. Paper 104
Poster CR-001
Poster EDU-060
Armstrong, Nicholas Poster SCI-033
Arva, Nicoleta Poster SCI-049
Ashton, Daniel Paper 046
Paper 048
Poster SCI-034
Poster SCI-038
Aslam, Madiha Paper 013
Paper 042
Paper 043
Atluri, Mahesh Paper 107
Augustyn, Robyn Paper 074
Avedian, Raffi S. Paper 086
Poster EDU-088
Averill, Lauren W. Paper 001 (T)
Ayyala, Rama Paper 157
Poster SCI-013
B
Baad, Michael Poster EDU-056
Back, Susan J. Paper 024
Paper 028
Paper 030
Badachhape, Andrew A. Paper 083
Paper 110
Badar, Zain Poster EDU-059
Poster EDU-075
Baida, Amal Poster EDU-009 (T)
Baikpour, Masoud Paper 146
Bailey, Smita Paper 012 (T)
Poster SCI-017
Baird, Grayson Paper 157
Bajno, Lydia M. Poster SCI-063
Bandarkar, Anjum Poster EDU-003 (T)
Banerjee, Imon Paper 102
Baraboo, Justin Paper 049
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S217
Bardo, Dianna M. Paper 074
Barillot, Christian Paper 090
Barkan, Guliz Poster SCI-054
Barnes, Craig Paper 012 (T)
Barnewolt, Carol E. Paper 139
Baron, Christopher Paper 053
Barrera, Christian A. Paper 032
Paper 035
Paper 036
Paper 097
Paper 109
Paper 144
Paper 147
Paper 148
Poster EDU-018
Poster EDU-057
Poster SCI-042
Barth, Richard Paper 023
Paper 151
Bathla, Girish Poster EDU-069
Bauer, Matthew Poster EDU-015
Beavers, Angela Poster EDU-063
Becker, Richard Poster EDU-014
Behr, Spencer Paper 082
Belasco, Jean Paper 040
Belchos, Jessica H. Poster SCI-011
Benali, Sébastien Paper 069
Bennett, Paula S. Paper 153
Berkovich, Rachel Poster EDU-081
Bertino, Frederic Paper 010
Paper 045
Bessom, David Poster EDU-041
Bhalla, Sanjeev Poster EDU-001
Bhatia, Aashim Paper 053
Bhatia, Anmol Poster SCI-068
Bhatt, Malay Poster EDU-049
Bhutta, Sadaf Poster EDU-002
Biko, David M. Paper 008 (T)
Paper 015 (T)
Paper 032
Paper 035
Paper 036
Paper 097
Paper 098
Paper 116
Paper 147
Poster SCI-042
Billmire, Deborah Poster EDU-020
Biyyam, Deepa R. Poster SCI-017
Blanchette, Victor Paper 142
Poster SCI-051
Blancq, Terry Paper 007 (T)
Blask, Anna Poster EDU-011
Poster EDU-014
Block, Tobias Poster SCI-027
Bloom, Glenn Paper 014 (T)
Poster EDU-004 (T)
Blum, Kevin Paper 115
Boguslavsky, Mark Paper 014 (T)
Boileau, Caroline Poster EDU-001 (T)
Boutet, Alexandre Paper 130
Bova, Davide Poster SCI-054
Bowden, Jonathan Paper 059
Poster SCI-046
Bowden, Sasigarn Paper 059
Poster SCI-046
Boyd, Kevin P. Poster EDU-055
Brahee, Deborah Poster EDU-028
Poster SCI-048
Braithwaite, Kiery Paper 076
Poster SCI-020
Poster SCI-021
Brattain, Laura Paper 146
Bray, Heather Paper 078
Poster EDU-052
Poster SCI-063
Breuer, Christopher Paper 115
Brian, Brazinski Paper 008 (T)
Brink, Farah Paper 113
Brondell, Ashley Paper 016 (T)
Brown, Brandon P. Paper 095
Paper 157
Poster EDU-007
Poster EDU-016
Poster SCI-011
Browne, Lorna Paper 105
Brudnicki, Adele Poster EDU-034
Bruneau, Bertrand Paper 090
Bryant, Audrey Poster CR-002 (T)
Buchmann, Robert F. Poster CR-004
Bulas, Dorothy Poster EDU-003 (T)
Poster EDU-009
Poster EDU-011
Poster EDU-014
Burgess, Matthew Poster EDU-015
Burke, Leah Poster EDU-051
Burton, Christiane Paper 051
Bush, Adam Paper 122
Paper 123
Bushur, Katherine M. Poster EDU-005 (T)
Buskirk, Tricia Poster EDU-040
Butler, Nikki Paper 006 (T)
Paper 011 (T)
Poster SCI-001 (T)
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S218
C
Cahill, Anne Marie Paper 011
Paper 013
Paper 014
Paper 040
Paper 041
Paper 042
Paper 043
Poster EDU-046
Poster EDU-047
Poster SCI-035
Poster SCI-037
Callahan, Michael J. Paper 077
Calle Toro, Juan S. Paper 028
Paper 148
Poster EDU-025
Calle-Toro, Juan S. Paper 040
Canning, Douglas Paper 030
Cao, Joseph Alt 001
Paper 015
Poster SCI-004
Poster SCI-056
Caro Domínguez, Pablo Paper 039
Carrasco, Rosario Poster EDU-094
Carson, Robert H. Paper 010 (T)
Paper 030
Caruso, Paul A Paper 055
Paper 056
Carver, Diana Paper 070
Castillo, Samantha Poster SCI-006
Caterini, Jessica Paper 137
Cauley, Steve Paper 055
Paper 056
Cervantes, Luisa F. Paper 034
Cha, Yoon Jin Paper 152
Chadha, Neil Paper 078
Chan, Alex Paper 125
Poster EDU-066
Poster EDU-071
Chan, Andrea Poster SCI-048
Chan, Frandics P. Paper 037
Chan, Sherwin S. Paper 049
Poster EDU-042
Chandra, Tushar Poster EDU-050
Charon, Valerie Paper 090
Chau, Alex Paper 046
Poster EDU-048
Poster SCI-038
Chauvin, Nancy Poster EDU-015 (T)
Chavhan, Govind B. Paper 004
Paper 039
Chawla, Soni Poster SCI-044
Cheah, Eugene Paper 146
Chen, Aaron Paper 021
Chen, Susie Poster EDU-062
Poster EDU-083
Cheng, Joseph Y. Paper 103
Paper 121
Paper 123
Paper 124
Poster SCI-059
Cheon, Jung-Eun Poster SCI-032
Poster SCI-045
Chi, Yueh-Yun Paper 029
Chiang, Michael Paper 119
Cho, Joo Poster EDU-041
Cho, Yeon Jin Poster SCI-032
Chock, Valerie Paper 088
Choi, Eun Hwa Poster SCI-045
Choi, Jungwhan J. Paper 051
Paper 108
Choi, Young Hun Paper 047
Poster SCI-032
Poster SCI-045
Choudhary, Arabinda Paper 125
Poster EDU-066
Poster EDU-071
Chow, Jeanne S. Paper 026
Chu, Zili D. Paper 129
Chung, Catherine Paper 012
Chung, Taylor Poster EDU-003
Poster EDU-035
Poster EDU-054
Cielma, Tara Poster CR-003 (T)
Poster EDU-003 (T)
Poster EDU-011
Poster EDU-070
Clarke, Rebekah Poster EDU-074
Cleary, Kevin Paper 008
Cleveland, Heather Paper 046
Poster SCI-038
Coblentz, Ailish Paper 130
Cohen, Sara Paper 032
Poster SCI-042
Cole, Elizabeth Poster SCI-059
Coleman, Beverly G. Paper 093
Paper 096
Coleman, Jay R. Poster EDU-087
Collard, Michael Poster EDU-068
Poster EDU-086
Poster EDU-087
Collins, Heather Poster SCI-015
Conaghan, Philip G. Poster EDU-061
Conklin, John Paper 055
Paper 056
Connolly, Bairbre Poster SCI-033
Coons, Barbara E. Paper 093
Copley, Lawson A. Paper 141
Cornwall, Roger Poster SCI-048
Corouge, Isabelle Paper 090
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S219
Cort, Kayla Paper 092
Paper 097
Poster EDU-008
Corwin, Frank Poster EDU-041
Courtier, Jesse Paper 065
Creeden, Sean Poster EDU-079
Criman, Erik Poster CR-006
Cuda, Suzanne E. Paper 031
D
Dabrowiecki, Alexander M. Poster SCI-036
Dahmoush, Hisham M. Poster EDU-079
Daldrup-Link, Heike E. Paper 081
Paper 086
Poster EDU-088
Danehy, Amy Paper 051
Daneman, Alan Poster SCI-067
Dao, Kimberly Paper 009
Darge, Kassa Paper 024
Paper 028
Paper 148
Davey, Marcus G. Paper 093
Davis, Alexis S. Paper 088
Davis, James Poster EDU-030
Davis, Joseph Poster SCI-055
Dawoud, Malik A. Poster CR-004
DeBari, Suzanne E. Paper 013 (T)
Paper 096
Degnan, Andrew J. Paper 017
Paper 064
Paper 144
Paper 163
Poster EDU-057
Poster EDU-062
Deng, Jie Poster SCI-049
Dennis, Rebecca A. Poster SCI-022
Dery, Julie Poster EDU-013
Desai, Sudhen Poster CR-011
Poster EDU-048
Deschenes, Sylvain Paper 069
Devgan, Arushi Poster EDU-029
Devkota, Laxman Paper 083
Paper 110
Dewitt, Aaron G. Paper 098
Paper 116
DeWitt, Peter E. Paper 105
Diaz, Edward Paper 023
Diaz, Eric Paper 120
Dick, Andre A. Alt 004
Didier, Ryne A. Paper 093
Paper 096
Dietz, Kelly Poster EDU-012
Dillard, Austin Poster EDU-026
Dillman, Jonathan R. Alt 003
Paper 003
Paper 005
Paper 006
Paper 007
Paper 084
Paper 150
Paper 153
Paper 154
Dixon, Chanae Poster EDU-067
Do, Synho Paper 094
Dome, Jeffrey Paper 029
Don, Steven Paper 072
Poster SCI-031
Donaldson, James Poster SCI-040
Doneva, Mariya Poster EDU-003
Donnelly, Lane F. Paper 159
Dori, Yoav Paper 008 (T)
Paper 097
Paper 098
Paper 116
Doria, Andrea Paper 087
Paper 137
Paper 142
Paper 155
Poster EDU-061
Poster SCI-041
Poster SCI-051
Dougherty, Ryne Poster EDU-022
Drubach, Laura Paper 080
Drum, Elizabeth Poster SCI-002 (T)
Dubay, Nicholas Paper 145
Dubois, Josée Paper 058
Paper 069
Poster EDU-005
Dugan, Monet Paper 026
Duis, Jessica Paper 053
Dunoski, Brian S. Poster SCI-001
Durand, Rachelle Paper 014
Paper 040
Paper 041
Durfee, Teela M. Poster CR-003 (T)
Poster EDU-003 (T)
Duron, Vincent Poster SCI-013
Durrence, Wesley Paper 044
E
Edgar, James Paper 011
Paper 021
Paper 092
Paper 109
Edwards, Emily A. Paper 065
Ehrlich, Peter Paper 029
Eing, Julee Paper 016
El-Ali, Alexander M. Paper 050
Eliades, Sarah Poster EDU-056
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S220
Elias, Gavin Paper 130
Elmore, Kate Poster SCI-002
Emery, Kathleen H. Poster SCI-048
Eng, David Paper 060
Englehardt, George Paper 008 (T)
Epelman, Monica Poster EDU-050
Escobar, Fernando Paper 013
Poster EDU-047
Poster SCI-037
Estroff, Judy A. Paper 106
Paper 108
Eutsler, Eric P. Paper 072
Evens, Ashley Poster CR-002
Everist, Mac Paper 060
Ewala, Stanley Paper 067
F
Fabregas, Jorge Paper 010
Fanelli, Gina Paper 002 (T)
Farkas, Amy Poster EDU-072
Farmakis, Shannon G. Alt 002
Farrell, Crystal R. Paper 086
Poster EDU-088
Fasano, Alfonso Paper 130
Fefferman, Nancy Paper 060
Fei, Lin Paper 005
Feinstein, Kate A. Poster EDU-024
Poster EDU-037
Poster SCI-005
Feldman, Brian Paper 137
Paper 142
Poster SCI-051
Fenlon, Edward P. Poster EDU-062
Poster EDU-083
Fernandez, Conrad V. Paper 029
Ferré, Jean-Christophe Paper 090
Ferrer, Christopher Paper 067
Ferretti, Emanuela Poster EDU-010
Ficicioglu, Can Poster EDU-057
Fickenscher, Kristin Poster EDU-042
Figueiro Longo, Maria Gabriela Paper 055
Paper 056
Filice, Ross Paper 060
Finkle, Joshua H. Paper 073
Poster SCI-005
Fish, Joel Poster SCI-041
Fitzpatrick, Laura A. Poster SCI-024
Flake, Alan W. Paper 093
Fleischmann, Dominik Paper 037
Flink Elmfors, Anton Paper 088
Flynn, John F. Poster EDU-021
Franc, Benjamin Paper 082
Francavilla, Michael L. Paper 003 (T)
Paper 004 (T)
Paper 014 (T)
Paper 017
Paper 060
Paper 109
Frankfurter, Caroline Frankfurter Poster SCI-065
Frasso, Rosemary Poster SCI-025
Freeman, Mary Paper 007 (T)
Friedman, Jonathan R. Paper 141
Frost, Jamie L. Poster EDU-006
Fulmer, J. M. Poster EDU-086
G
Gaballah, Marian Poster EDU-096
Gaesser, Jenna Poster EDU-073
Ganapathy, Shankar S. Poster EDU-017
Ganley, Theodore Paper 144
Gardler, Jenelle L. Paper 013 (T)
Garel, Juliette Poster EDU-013
Gariepy, Cheryl Paper 149
Garrett, Whitney Poster EDU-040
Gebarski, Kathleen Poster EDU-030
Gedela, Satya Poster SCI-058
Gee, Michael S. Paper 055
Paper 056
Paper 094
Paper 109
Paper 146
Gelfond, Jonathan Paper 111
Geller, James Paper 029
Gerard, Perry Poster EDU-034
Ghaghada, Ketan B. Paper 083
Paper 110
Gholipour, Ali Paper 106
Ghosh, Shanchita Paper 128
Gill, Anne Paper 010
Paper 016 (T)
Paper 044
Paper 045
Poster SCI-036
Gill, Jacqueline K. Paper 007
Gilligan, Leah A. Alt 003
Paper 003
Paper 007
Paper 154
Gillman, Jennifer Poster SCI-062
Gillum, Jason Paper 080
Ginader, Abigail Paper 156
Goehner, Melissa Paper 006 (T)
Poster EDU-007 (T)
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S221
Gokli, Ami Paper 019
Paper 158
Paper 160
Paper 161
Paper 162
Goldfarb, Samuel Poster EDU-044
Goldfisher, Rachelle Poster EDU-096
Goldstein, Amy Paper 134
Goman, Simal Paper 012
Goncales, Fabricio G. Paper 134
Gonzalez, Ivan Paper 128
Gonzalez-Gomez, Ignacio Poster CR-002
Goodarzian, Fariba Poster EDU-081
Gordon, Leslie Paper 066
Gould, Sharon W. Poster SCI-008
Govind, Varan Paper 128
Grasparil, Angelo Don II Paper 004
Grassi, Daphine Paper 085
Grattan-Smith, Damien Paper 052
Paper 057
Gray, Brian W. Poster SCI-011
Green, Jared Poster SCI-040
Green, Jesse Poster SCI-001 (T)
Gregory, Casey L. Paper 013 (T)
Grehten, Patrice Paper 027
Grey, Neil Paper 105
Griffith, Michael Paper 065
Grissom, Leslie Paper 001 (T)
Groene, John J. Poster EDU-024
Grosse-Wortmann, Lars Paper 039
Gruber, Joshua B. Paper 034
Guillot, Gerald Paper 022
Guimaraes, Carolina Poster EDU-079
Guo, Chen Poster SCI-007
Poster SCI-018
Gupta Pankaj Poster SCI-066
Gupta, Rachita Poster EDU-077
Gupta, Saurabh Poster EDU-059
Poster EDU-075
H
Hailu, Tigist Paper 156
Poster SCI-025
Halabi, Safwan Paper 023
Paper 060
Paper 107
Hammer, Matthew R. Paper 141
Poster EDU-038
Hammill, Adrienne M Paper 101
Han, Kyunghwa Paper 152
Handa, Atsuhiko Poster EDU-058
Poster EDU-084
Hanzlik, Emily Paper 127
Hardy, Anna Alt 002
Hargreaves, Brian Paper 136
Harris, Chris Poster SCI-002 (T)
Harris, Lisa K. Paper 145
Hartung, Helge Paper 147
Harty, M. P. Poster SCI-008
Hasweh, Reem Paper 084
Poster EDU-031
Hawkins, C. Matthew Paper 010
Paper 016 (T)
Paper 044
Paper 045
Poster SCI-036
Heitzmann, Mark Poster EDU-015
Henry, M Katherine Paper 017
Hernandez, Alberto J. Paper 046
Poster SCI-038
Hernanz-Schulman, Marta Paper 070
Herregods, Nele Poster EDU-061
Heuer, Gregory G. Paper 096
Hibbard, Roberta Paper 112
Higgins, Timothy Poster EDU-051
Highmore, Kerri Poster EDU-001 (T)
Hildebrand, Andrea Poster EDU-051
Hill, Ann Poster SCI-015
Hill, Lamont Paper 014 (T)
Poster SCI-022
Himes, Ryan Paper 046
Hinostroza, Virginia Paper 037
Hippe, Daniel Paper 132
Hirsig, Leslie E. Poster SCI-015
Hitt, Dave Poster EDU-003
Poster EDU-054
Hoffer, Fredric Paper 029
Ho-Fung, Victor Paper 011
Paper 017
Paper 064
Poster EDU-015 (T)
Poster EDU-057
Hogan, James Poster SCI-025
Holdener, Ruth Paper 072
Holm, Tara Poster EDU-012
Holroyd, Alexandria J. Alt 005
Hook, Marcus I. Poster EDU-051
Hopely, Brian Paper 161
Paper 162
Hor, Kan Paper 115
Poster SCI-009
Poster SCI-010
Horak, Richard D. Poster CR-006
Horiuchi, Tetsuya Poster SCI-014
Howell, Lori J. Paper 096
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S222
Hu, Houchun Paper 054
Paper 059
Paper 115
Paper 149
Poster EDU-040
Poster SCI-027
Poster SCI-030
Poster SCI-043
Poster SCI-046
Poster SCI-050
Poster SCI-069
Hu, Li-Wei Poster SCI-007
Poster SCI-018
Hu, Yuxin Paper 136
Huang, Chao Paper 094
Huang, Hao Paper 089
Paper 091
Huang, Susie Yie Paper 055
Paper 056
Huang, Yungui Poster EDU-040
Hui, Thomas Poster EDU-035
Hulett-Bowling, Rebecca Poster EDU-094
Hull, Nathan Poster SCI-055
Hunter, Kyle Poster EDU-017
Hur, Saebeom Poster SCI-032
Hutchinson, Marcy L. Paper 013 (T)
Poster EDU-015 (T)
Hwang, Jae- Yeon Poster SCI-052
Hwang, Misun Paper 089
Paper 091
Paper 092
Poster EDU-008
Poster SCI-022
I
Iaia, Alberto Poster EDU-066
Poster EDU-071
Ibe, Donald O. Poster CR-001
Ibrahim, Ala' Y. Paper 104
Ibrahim, George Paper 130
Inaba, Hiroto Poster SCI-019
Inarejos, Emilio C. Poster EDU-061
Infante, Juan C. Paper 034
Irahara, Saho Poster SCI-012
Irani, Neville Paper 060
Iyer, Ramesh Alt 004
Paper 131
Paper 132
Poster EDU-021
Poster SCI-028
J
Jacobs, Shimon Poster SCI-013
Jadhav, Siddharth P. Paper 033
Paper 038
Paper 117
Paper 118
Paper 120
Jaimes, Camilo Paper 055
Paper 056
Paper 094
Paper 109
Jain, Neil K. Paper 011
Jaju, Alok Poster EDU-067
Jakab, Andras Paper 027
Jane Borst, Alexandra Paper 053
Janitz, emily Poster EDU-017
Jans, Lennart Poster EDU-061
Jaramillo, Diego Poster EDU-062
Poster EDU-083
Jaremko, Jacob L. Poster EDU-061
Jea, Andrew Paper 095
Jeha, Sima Poster SCI-019
Jenkins, Dorothea Poster SCI-015
Jennings, Greg Paper 112
Jennings, Russell Paper 100
Ji, Dabin Paper 044
Jiang, Jingying Paper 151
Jin, Ning Paper 054
Johnson, Ann Paper 017
Paper 092
Johnson, Brittany Poster CR-011
Johnson, Craig Poster SCI-023
Johnson, Maggie Paper 009 (T)
Johnston, Patrick Paper 009
Paper 066
Johnston, Thomas P. Poster SCI-009
Poster SCI-010
Jones, Anji Poster SCI-005
Jones, Jeremy Poster SCI-058
Jones, Richard Paper 052
Paper 057
Joyner, David Poster EDU-072
Ju, Zhaoru Paper 151
Junhasavasdikul, Thitiporn Paper 087
K
Kadom, Nadja Paper 060
Paper 163
Kammen, Bamidele Poster EDU-035
Poster EDU-054
Kamps, Shawn Alt 004
Kan, J. H. Paper 061
Paper 062
Paper 063
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S223
Kanamori, Yutaka Poster SCI-012
Kandil, Ali Poster CR-002 (T)
Kandula, Vinay V. Paper 125
Poster EDU-066
Poster EDU-071
Kaplan, Summer Paper 017
Paper 021
Paper 060
Paper 064
Paper 085
Poster SCI-042
Kapoor, Cassandra Poster EDU-001 (T)
Karakas, S Pinar Poster EDU-035
Poster EDU-054
Karastanovic, Merima Paper 002 (T)
Karczewski, Arleen Poster EDU-040
Karmazyn, Boaz Paper 001
Paper 095
Paper 112
Poster EDU-020
Karol, Seth Poster SCI-019
Karuppiah Viswanathan, Ashok Mithra Poster EDU-064
Karwowska, Anna Paper 022
Kavita, Patel Paper 044
Kelleher, Sean Poster SCI-029
Kellenberger, Christian J. Paper 027
Kellogg, Nancy Paper 111
Kelly, John M. Paper 115
Kennedy II, William A. Paper 023
Kephart, Morie Paper 050
Ketwaroo, Pamela Paper 033
Paper 120
Khalek, Nahla Paper 096
Khandwala, Nishith Paper 060
Khanna, Geetika Paper 002
Paper 029
Poster SCI-060
Khrichenko, Dmitry Paper 147
Khwaja, Asef Paper 021
Poster EDU-004 (T)
Kijowski, Richard Paper 144
Kilborn, Tracy Poster SCI-053
Kilic, Aishe I. Poster SCI-054
Killeen, Amy Poster SCI-031
Kim, AeRang Paper 138
Kim, Hee K Paper 101
Kim, In-One Poster SCI-032
Poster SCI-045
Kim, Jane Poster EDU-019
Kim, Lily H. Paper 107
Kim, Myung-Joon Paper 152
Kim, Sunghoon Poster EDU-035
Kim, Woo Sun Poster SCI-032
Poster SCI-045
Kim, Yongwoo Poster SCI-052
Kim, Yu Jin Paper 047
Kini, Viswanatha Poster CR-005
Kino, Aya Paper 037
Kirby, Courtney M. Paper 016
Paper 164
Kirkhus, Eva Poster EDU-061
Kirsch, Alyssa Poster EDU-049
Kirsch, John E. Paper 055
Paper 056
Kleinman, Monica Paper 066
Kline-Fath, Beth M. Paper 107
Koci, Martin Paper 151
Paper 165
Kohli, Mandy L. Poster SCI-065
Kolon, Thomas Paper 030
Kong, Melissa C. Poster SCI-064
Koning, Jeffrey Poster CR-008
Koshy, Sheeja M. Poster CR-005
Kovanlikaya, Arzu Poster EDU-056
Kozak, Brandi Poster EDU-015 (T)
Poster EDU-018 (T)
Kralik, Stephen F. Paper 095
Kramer, Robert E. Paper 105
Kraus, Steve Poster EDU-026
Krauss, Jillian R. Poster EDU-053
Krishnamurthy, Ganesh Paper 011
Krishnamurthy, Rajesh Paper 016
Paper 020
Paper 059
Paper 115
Paper 149
Paper 164
Poster EDU-040
Poster SCI-009
Poster SCI-010
Poster SCI-027
Poster SCI-029
Poster SCI-030
Poster SCI-043
Poster SCI-046
Poster SCI-050
Poster SCI-069
Krishnamurthy, Ramkumar Paper 020
Paper 054
Paper 059
Paper 115
Paper 149
Poster EDU-040
Poster SCI-009
Poster SCI-010
Poster SCI-027
Poster SCI-029
Poster SCI-030
Poster SCI-043
Poster SCI-046
Poster SCI-050
Krishnasarma, Rekha Paper 127
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S224
Krofchik, Lisa Paper 050
Kruk, Peter Poster CR-008
Ksiazek, Kathleen Poster EDU-016 (T)
Kukreja, Kamlesh Poster CR-010
Poster EDU-048
Kurugol, Sila Paper 026
Kwatra, Neha Paper 080
Kwon, Jeannie Alt 001
Paper 015
Poster EDU-038
Poster EDU-068
L
Lai, Lillian Poster EDU-081
Lai, Peng Paper 124
Lala, Shailee Paper 060
Lall, Neil Poster EDU-043
Lam, Christopher Paper 039
Lam, Simon Paper 154
Lambert, Robert Poster EDU-061
Lanier, Michael H. Paper 002
Laor, Tal Paper 066
Lapierre, Chantale Paper 058
Poster EDU-005
Poster EDU-013
Laporte, Jennifer Paper 010
Larson, Shelby Poster EDU-093
Latshaw, Rachael Poster EDU-066
Poster EDU-071
Laughlin, Brady Poster EDU-066
Poster EDU-071
Lautz, Timothy Paper 073
Lavelle, Tara A. Paper 163
Lawrence, John T. Paper 064
Lawrence, Kendall Paper 093
Laxer, Ronald Poster SCI-041
Le, Hau D. Poster CR-014
Leake, James Poster EDU-089
LeCompte, Lesli Poster EDU-034
Lee, Anna Paper 078
Poster EDU-052
Lee, Dawnisha Paper 156
Lee, Edward Poster EDU-090
Poster SCI-068
Lee, Hyunkwang Paper 094
Lee, Mi-Jung Paper 152
Lee, Richard Paper 026
Lee, Seunghyun Poster SCI-032
Lee, Simon Poster SCI-009
Poster SCI-010
Legouhy, Antoine Paper 090
Leroux, Stéphanie Paper 090
Lewis, Kenneth Paper 070
Li, Tianyang Poster EDU-004
Poster EDU-034
Liang, Teresa Poster EDU-090
Lillehei, Craig Paper 077
Lim-Dunham, Jennifer E. Poster SCI-054
Lin, Michael F. Paper 072
Lin, Simon Poster EDU-040
Lindsay, Eduardo A. Paper 141
Little, Stephen Paper 052
Paper 057
Liu, Mandi Paper 098
Paper 116
Liu, Shaoling Paper 151
Liu, Xiaozhou Poster EDU-076
Livingston, Kristin S. Paper 065
Lo, Cecilia W. Poster EDU-073
Loescher, Viky Paper 034
Loewen, Jonathan M. Paper 076
Poster SCI-020
Poster SCI-021
Loken, Eric Poster EDU-041
Lombardi, Allison Poster EDU-014 (T)
Long, Alexander Poster SCI-058
Loomis, Judyta Poster EDU-003 (T)
Poster EDU-011
Poster EDU-014
Poster EDU-070
Lori, Schoenbrun Poster EDU-073
Lovejoy, John F. Poster EDU-050
Lozano, Andres Paper 130
Lu, Quin Paper 107
Paper 119
Poster EDU-003
Poster EDU-054
Lu, Zheng Feng Poster SCI-005
Lubeley, Lacey J. Paper 054
Poster EDU-040
Lucky, Anne Poster EDU-023
Luna, John Poster EDU-040
Lungren, Matthew Paper 102
Luo, Yu Poster CR-007
Lustig, Michael Paper 135
Lyon, Jane B. Poster CR-014
M
Ma, Grace M. Paper 077
Ma, Jihyun Paper 145
MacKenzie, John D. Paper 065
MacLean, Joseph R. Poster EDU-019 (T)
Maddocks, Alexis B. Poster EDU-062
Poster EDU-083
Poster SCI-013
Magee, Ralph Poster EDU-008 (T)
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S225
Mah, Douglas Y. Paper 080
Mahant, Sanjay Poster SCI-033
Mahdi, Eman S. Poster EDU-009
Mahmood, Sulman Paper 011
Maier, Pia Poster EDU-044
Majeed, Haris Paper 142
Poster SCI-051
Majmudar, Anand Poster EDU-059
Poster EDU-075
Maksymowych, Walter P. Poster EDU-061
Maleeva, Aneliya Poster SCI-054
Maleki, Maryam Paper 126
Malik, Archana Poster EDU-032
Malkin, David Paper 087
Mallon, Mea Poster EDU-032
Malone, Jason Poster EDU-050
Malone, LaDonna Paper 105
Maloney, Ezekiel Paper 131
Paper 132
Poster EDU-021
Maloney, Thomas Poster SCI-048
Man, Carina Paper 137
Paper 142
Paper 155
Poster SCI-051
Mangona, Kate Louise M. Alt 001
Paper 015
Poster EDU-038
Poster EDU-068
Mangus, Richard S. Paper 001
Marie, Eman E. Paper 155
Poster EDU-060
Marine, Megan B. Paper 112
Poster EDU-020
Markowitz, Richard Paper 017
Marrocco, Michael Poster SCI-031
Marshall, Emily Poster SCI-005
Marshall, Kelley W. Paper 010
Martin, Brendan Poster SCI-054
Martin, Robert Poster SCI-025
Martinez-Rios, Claudia Poster EDU-010
Martin-Saavedra, Juan S. Paper 089
Paper 091
Paper 096
Paper 134
Poster EDU-042
Masand, Prakash Paper 033
Paper 038
Paper 117
Paper 118
Paper 120
Poster CR-010
Masseaux, Joy Paper 067
Masum, Rukya Poster EDU-067
Matheney, Travis Paper 139
Mathew, Joseph Poster SCI-066
Poster SCI-068
Matsuzaki, Yuichi Paper 115
Matthay, Katherine Paper 082
Maule, Trista Paper 011 (T)
Maza, Noor M. Paper 067
Mazille, Nadia Paper 090
McAllister, Aaron S. Paper 016
Paper 054
Poster EDU-040
Poster SCI-058
McCarville, Beth Poster SCI-019
McCleary, Brendan Paper 005
Paper 006
McCrary, Joseph Poster EDU-027
McCuaig, Catherine Poster EDU-005
McGee, Jack Poster EDU-043
McGonagill, Phillip Paper 016
Paper 020
Paper 164
Poster SCI-030
Mecca, Patricia Paper 035
Medina Perez, Mariangeles Poster EDU-059
Poster EDU-075
Mega, James Poster CR-006
Mehta, Akshita Poster EDU-076
Meister, Moshe Poster EDU-019
Mejia, Erika J. Paper 098
Mejias, Asuncion Poster SCI-069
Melis, Tomas Paper 165
Menashe, Sarah Paper 132
Menini, Anne Paper 136
Menzel, Meg Poster EDU-011
Mercado-Deane, Maria-Gisela Paper 031
Paper 111
Mesi, Erin L. Paper 016
Paper 164
Messer, Diana L. Paper 113
Metts, Brent Poster EDU-041
Metz, Terrence Poster EDU-049
Meyers, Arthur B. Poster EDU-050
Poster EDU-061
Meyers, Kevin Paper 042
Paper 043
Meyers, Mariana L. Poster EDU-007
Mhlanga, Joyce Poster SCI-060
Miethke, Alexander G. Paper 154
Milks, Kathryn S. Poster SCI-043
Poster SCI-050
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S226
Milla, Sarah Paper 060
Paper 076
Poster CR-013
Poster SCI-020
Poster SCI-021
Miller, Angie L. Paper 105
Miller, Elka Paper 022
Poster EDU-001 (T)
Poster EDU-010
Miller, Russell Poster SCI-013
Minifee, Paul Poster CR-011
Misiura, Anne K. Poster EDU-032
Mitchell, Grace Poster EDU-093
Miyasaka, Mikiko Poster SCI-012
Miyazaki, Osamu Poster SCI-012
Poster SCI-014
Moftakhar, Parham Poster EDU-066
Poster EDU-071
Mohanta, Arun Poster SCI-041
Moldenhauer, Julie S. Paper 096
Molto, Jose Poster EDU-070
Monfaredi, Reza Paper 008
Mong, David A. Paper 102
Monn, Danielle Paper 095
Moore, Theresa Paper 001 (T)
More, Snehal R. Paper 033
Moredock, Elisabeth Poster EDU-086
Morgan, Trudy Paper 015 (T)
Paper 024
Paper 097
Morin, Cara Poster SCI-019
Muehe, Anne M. Paper 081
Paper 086
Poster EDU-088
Mueller, Mallory Paper 008 (T)
Mullen, Elizabeth Paper 029
Muniz, Juan Carlos Paper 034
Munyon, Roxanne Paper 002 (T)
Muraresku, Colleen Paper 134
Murati, Michael A. Poster EDU-012
Murotsuki, Jun Poster SCI-014
Murphy, Nicole Paper 073
Murphy, Ryan Poster EDU-012
Murray, Becky Poster SCI-069
Muthiyal, Sreekumar Poster CR-005
Muthusami, Prakash Poster SCI-033
Myers, Ross A. Poster EDU-004
Poster EDU-034
N
Nadel, Helen R. Poster SCI-063
Poster SCI-064
Nathalie, Fleming Paper 022
Navallas Irujo, Maria Poster CR-001
Poster SCI-067
Ndolo, Josephine M. Paper 053
Neumann, Peter J. Paper 163
Neville Kucera, Jennifer Poster CR-002
Nevo, Elad Poster EDU-008 (T)
Newman, Beverley Poster EDU-091
Nguyen, Jie C. Paper 064
Paper 092
Paper 144
Poster SCI-042
Nicholas, Jennifer L. Poster SCI-031
Nichols, Reid Paper 026
Nicolas, Amelie Paper 090
Nigro, Alessandria Paper 156
Nikam, Rahul Paper 125
Poster EDU-066
Poster EDU-071
Nishimura, Dwight G. Paper 103
Nishimura, Gen Poster EDU-058
Poster SCI-014
Noel, Cory Paper 117
aper 118
Noorbakhsh, Abraham Poster CR-008
Northern, Nathan Paper 150
Nosaka, Shunsuke Poster SCI-012
Nowik, Christina Poster CR-003
Nozaki, Taiki Poster EDU-084
O
O'Donovan, Julie C. Poster SCI-069
O'Neill, Thomas Paper 015
Oetgen, Matthew Poster EDU-014
Okamato, Reiko Poster SCI-012
Oliveira, Lais Paper 130
Oliver, Brianna Poster EDU-036
Oliver, Edward R. Paper 096
Ong, Seng Poster EDU-024
Poster EDU-037
Orscheln, Emily Paper 084
Ortiz, Carlos B. Poster EDU-048
Ostendorf, Adam Poster SCI-058
Ostrowski, John W. Poster SCI-008
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S227
Otero, Hansel J. Paper 017
Paper 028
Paper 032
Paper 035
Paper 036
Paper 092
Paper 097
Paper 098
Paper 116
Paper 147
Paper 148
Paper 163
Poster EDU-004 (T)
Poster EDU-018
Otobo, Tarimobo M. Poster EDU-061
Otto, Randolph K. Paper 131
Paper 132
Poster SCI-028
Ouyang, Minhui Paper 089
Paper 091
Ouyang, Rong-Zhen Poster SCI-007
Ozturk, Arinc Paper 146
P
Paden, Matthew Paper 044
Padua, Eric Poster EDU-054
Pagano, Lindsay Paper 127
Pahlka, Raymond B. Paper 079
Palasis, Susan Paper 052
Paldino, Michael Paper 129
Paltiel, Harriet Paper 139
Pandya, Nirav Poster EDU-054
Panigrahy, Ashok Poster EDU-073
Panwar, Jyoti Poster EDU-061
Panwar, Sanuj Paper 087
Parad, Richard B. Paper 106
Parakh, Anushri Paper 094
Pareek, Anuj Poster EDU-088
Parent, Stefan Paper 069
Parihar, Robin Paper 083
Parisi, Marguerite Alt 004
Park, Ellen S Poster EDU-035
Parra, Dimitri Poster SCI-033
Parsons, Matthew Poster SCI-057
Parthasarathy, Jayanthi Poster SCI-047
Poster SCI-058
Patel, Akash Poster EDU-082
Patel, Amy Poster EDU-093
Patel, Dhruv Paper 076
Poster SCI-020
Poster SCI-021
Patel, Falguni Poster EDU-011 (T)
Patel, Mittun Paper 074
Patel, Niki Poster EDU-072
Patel, Nimai Poster SCI-023
Paul, Mary Poster EDU-034
Pauly, John Poster SCI-059
Payne, Erin Poster EDU-042
Pednekar, Amol Paper 117
Paper 118
Paper 120
Perez, Francisco Paper 131
Paper 132
Perez, Manuela Poster EDU-060
Poster EDU-061
Perez Matta, Maria Manuela Poster SCI-041
Perez Trejo, Maria Esther Paper 022
Perlman, Elizabeth Paper 029
Perrin Hee, Thor Paper 144
Persohn, Scott A. Paper 095
Pezeshkpour, Paymun Paper 012
Paper 137
Poster SCI-033
Pfeifer, Cory M. Paper 158
Poster CR-012
Poster EDU-068
Poster EDU-074
Poster EDU-076
Poster EDU-086
Poster EDU-087
Poster EDU-089
Poster EDU-095
Poster SCI-003
Poster SCI-004
Poster SCI-006
Poster SCI-056
Pham, Huy Poster SCI-002
Phelps, Andrew Paper 065
Paper 082
Phillips, James D. Paper 053
Phillips, Grace Alt 004
Phinizy, Pelton Poster SCI-058
Piccione, Joseph Poster EDU-044
Pierce, Theodore T. Paper 146
Pindrik, Jonathan Poster SCI-058
Pinson, Monica C. Poster EDU-007 (T)
Pinto, Erin Paper 097
Paper 098
Paper 116
Piskunowicz, Maciej Poster EDU-008
Plishker, William Poster SCI-039
Poletto, Erica Poster EDU-032
Politte, David Paper 072
Pomeranz, Christy B. Poster EDU-056
Ponisio, Maria R. Poster SCI-060
Ponrartana, Skorn Paper 119
Poon, Mimi Paper 082
Pope, Elena Poster SCI-041
Porayette, Prashob Paper 039
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S228
Potter, Carol Paper 149
Potts, James E. Poster SCI-063
Poster SCI-064
Potts, Jim Paper 078
Powell, Julie Paper 058
Powers, Andria M. Poster EDU-063
Poznick, Laura Paper 024
Prabhu, Sanjay P. Paper 060
Paper 100
Prevett, Georgiena E. Paper 005 (T)
Pribnow, Allison Poster EDU-088
Prince, Jeffrey S. Paper 068
Priya, Sarv Poster EDU-069
Proisy, Maïa Paper 058
Paper 090
Poster EDU-005
Prologo, John David Paper 010
Pruthi, Sumit Paper 127
Pugash, Denise Poster CR-003
Q
Qureshi, Athar Paper 038
R
Raboisson, Marie-Josee Poster EDU-013
Radhakrishnan, Rupa Paper 095
Rai, Aayushi Poster EDU-077
Rajan, Deepa S. Poster EDU-073
Rajeswaran, Shankar Poster SCI-040
Ramachandran, Amrutha Paper 128
Ramachandran, Shreya Paper 123
Ramilo, Octavio Poster SCI-069
Ramirez Giraldo, Juan Carlos Paper 075
Paper 099
Ranade, Sheena Paper 067
Randle, Stephanie Paper 131
Rapalino, Otto Paper 055
Paper 056
Rapp, Jordan B. Paper 036
Raptis, Demetrios Poster EDU-001
Raubenheimer, Lauren A. Poster SCI-053
Rayner, Tammy Paper 137
Rees, Mitchell Poster SCI-043
Poster SCI-047
Poster SCI-050
Reid, Janet R. Paper 019
Paper 040
Paper 085
Paper 160
Paper 161
Paper 162
Poster EDU-033
Poster SCI-062
Reimer, Nickolas Paper 010
Reiser, Ingrid Poster SCI-005
Reisner, Andrew Paper 052
Rempell, Rachel Paper 021
Rendon, Kathleen A. Poster EDU-002 (T)
Reyes Avila, Fiama Paper 128
Ricci, Angelo Paper 155
Richardson, Rebecca Poster SCI-019
Richer, Edward Paper 076
Poster SCI-020
Poster SCI-021
Riegert, Kimberly M. Poster SCI-001 (T)
Riemann, Monique Paper 012 (T)
Rigsby, Cynthia K. Paper 073
Poster EDU-002 (T)
Ringertz, Hans Paper 088
Riotti, Jessica Paper 128
Rivas, Charlotte H. Paper 083
Rizarri, Gilbert Paper 033
Roberts, Dustin G. Poster SCI-044
Robinson, Amie L. Poster EDU-042
Robson, Caroline Paper 108
Rodriguez, Diana P. Poster EDU-080
Romberg, Erin Poster EDU-002
Rome, Jonathan J. Paper 098
Paper 116
Rooks, Veronica J. Poster CR-006
Rosenbaum, Daniel Poster CR-003
Rosenberg, Henrietta K. Paper 067
Rosenberg, Jarrett Paper 086
Paper 151
Ross, Steven A. Paper 071
Rowell, Amy Poster EDU-029
Roy-Beaudry, Marjolaine Paper 069
Roytman, Michelle Poster EDU-056
Rubert, Nicholas Paper 074
Rubesova, Erika Paper 023
Paper 088
Paper 151
Poster EDU-013 (T)
Rubio, Eva Poster EDU-011
Poster EDU-014
Ruess, Lynne Poster SCI-026
Rumsy, Dax Poster EDU-061
Ruzal-Shapiro, Carrie Poster EDU-083
Ryan, Maura Poster EDU-067
Rypens, Francoise Paper 058
Poster EDU-005
Poster EDU-013
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S229
S
Saade-Lemus, Sandra Paper 021
Paper 089
Paper 091
Sadowsky, David Poster EDU-004
Poster EDU-034
Saffari, Seyed Ehsan Paper 018
Saglam, Dilek Paper 001
Paper 112
Sago, Haruhiko Poster SCI-012
Saigal, Gaurav Paper 128
Saini, Rimpi Poster EDU-093
Saker, Martha Paper 002 (T)
Salastekar, Ninad Poster EDU-059
Poster EDU-075
Samet, Jonathan Poster EDU-053
Poster SCI-040
Poster SCI-049
Samir, Anthony E. Paper 146
Sammer, Marcus Paper 159
Sammer, Marla Paper 159
Sammet, Christina L. Paper 073
Samora, Julie B. Poster SCI-026
Samujh, Ram Poster SCI-068
Sandberg, Jesse Paper 023
Paper 029
Paper 135
Paper 136
Paper 151
Sanders, Vanessa Poster SCI-060
Sandgren, Tuva Paper 088
Sandhya, Pulukool Poster EDU-061
Sandino, Christopher Paper 121
Paper 122
Paper 123
Paper 124
Paper 136
Sankaran, Akila Paper 020
Poster SCI-030
Sarkar, Korak Poster EDU-043
Sarkar, Poonam Paper 110
Sarma, Asha Paper 127
Sato, T Shawn Poster EDU-069
Saul, David Paper 015 (T)
Paper 017
Paper 032
Paper 035
Paper 036
Paper 097
Paper 116
Savage, Tara Paper 160
Sawai, Hideaki Poster SCI-014
Saxena, Akshay Poster SCI-066
Schafernak, Kristian Poster SCI-049
Schapiro, Andrew H. Alt 003
Scharschmidt, Thomas Poster SCI-047
Schenker, Kathleen Paper 001 (T)
Schloss, Brian Paper 020
Schmidt, Susan E. Alt 001
Paper 015
Poster SCI-056
Schmiedeskamp, Heiko Paper 037
Schmit, Pierre Poster SCI-024
Schmithorst, Vincent Poster EDU-073
Schneeman, Libby Poster EDU-004 (T)
Schooler, Gary Poster SCI-055
Scribano, Philip Paper 017
Seed, Mike Paper 039
Seekins, Jayne M. Paper 081
Seghers, Victor J. Paper 079
Sellers, Emily Poster EDU-037
Selvaraj, Bhavani Paper 054
Poster SCI-047
Poster SCI-058
Seo, Youngho Paper 082
Serai, Suraj Paper 005
Paper 019
Paper 030
Paper 109
Paper 147
Paper 148
Poster EDU-057
Poster SCI-042
Servaes, Sabah Paper 017
Paper 029
Poster SCI-062
Setser, Randolph M. Poster EDU-047
Setsompop, Kawin Paper 055
Paper 056
Setty, Bindu Poster EDU-077
Shah, Jay Paper 010
Paper 044
Paper 045
Shah, Kejal Paper 115
Shah, Summit H. Poster SCI-029
Poster SCI-030
Shaikh, Raja Paper 009
Shammas, Amer Poster SCI-065
Shankar, Anand Paper 149
Shannon, LeAnn M. Poster EDU-085
Shapira - Zaltsberg, Gali Paper 022
Sharma, Aseem Poster SCI-057
Sharma, Karun Paper 008
Paper 138
Poster SCI-039
Sharp, Susan E. Paper 060
Shaun, Hoffacker Paper 008 (T)
Shaw, Dennis W. Paper 131
Paper 132
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S230
Shekdar, Karuna Paper 134
Poster EDU-033
Shekhar, Raj Poster SCI-039
Shellikeri, Sphoorti Paper 011
Paper 014
Paper 024
Paper 040
Paper 041
Paper 042
Paper 043
Poster EDU-046
Poster EDU-047
Poster SCI-035
Shelton, Peter Poster SCI-031
Shenouda, Nazih Poster CR-009
Shepherd, Ashley M. Paper 035
Sher, Andrew Paper 079
Sheriff, Samar Poster EDU-023
Shet, Narendra S. Paper 138
Poster EDU-021
Sheybani, Elizabeth Paper 004
Shin, Hyun Joo Paper 152
Shin, Jaeseung Paper 152
Shin, Su-Mi Paper 101
Shinoka, Toshiharu Paper 115
Shipman, Molly Paper 098
Paper 116
Shipp, Rozalon M. Paper 007 (T)
Shpanskaya, Katie Paper 107
Paper 126
Shum, Thomas Poster SCI-038
Siddiqui, M.A. Alt 002
Siedek, Florian Paper 086
Siegel, Marilyn J. Paper 075
Paper 099
Silvestro, Elizabeth Paper 003 (T)
Paper 004 (T)
Paper 013 (T)
Paper 014 (T)
Paper 024
Paper 030
Paper 041
Poster EDU-044
Poster SCI-022
Poster SCI-035
Simone, Appenzeller Poster EDU-061
Simoneaux, Stephen Poster EDU-007 (T)
Poster EDU-009 (T)
Poster SCI-001 (T)
Singh, Sudha Poster EDU-085
Smith, Christopher L. Paper 008 (T)
Paper 098
Paper 116
Smith, Ethan A. Paper 029
Paper 084
Smith, Mark Paper 054
Smyth, Anna Poster CR-003
Poster EDU-052
Snyder, Elizabeth Paper 070
Sodhi, Kushaljit S. Poster SCI-066
Poster SCI-068
Solanki, Hemali Paper 004
Son, Jennifer K. Poster EDU-019
Sonke, Pierre-Yves Poster EDU-004
Southard, Richard Paper 074
Spiller, Lora Paper 111
Spunt, Sheri Paper 086
Squires, Judy H. Paper 050
Sreedher, Gayathri Poster EDU-017
Sridharan, Anush Paper 093
Srinivasan, Abhay Paper 011
Paper 013
Paper 040
Paper 041
Paper 042
Paper 043
Poster EDU-047
Srivastava, Mayank Paper 083
Paper 110
Stahoviak, Katherine L. Poster EDU-037
Stanescu, A. Luana Alt 004
Paper 131
Paper 132
Poster SCI-028
Stanley, Charles T. Poster CR-001 (T)
Poster EDU-010 (T)
Stanley, Parker T. Poster CR-001 (T)
Poster EDU-010 (T)
Poster EDU-013 (T)
Starosolski, Zbigniew A. Paper 061
Paper 062
Paper 063
Paper 083
States, Lisa Alt 005
Paper 017
Paper 085
Poster EDU-008 (T)
Poster EDU-082
Poster SCI-062
Steffner, Robert Poster EDU-088
Stein, Deborah Paper 106
Steinhardt, Nicole P. Poster EDU-007
Stewart, Zachary E. Poster SCI-002
Stimec, Jennifer Poster EDU-060
Poster EDU-061
Stoianovici, Dan Paper 008
Strouse, Peter Poster EDU-030
Strubel, Naomi Paper 060
Stupin, Igor Paper 083
Paper 110
Su, Wendy Poster EDU-035
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S231
Subramanian, Subramanian Paper 050
Poster EDU-073
Sudol-Szopinska, Iwona Poster EDU-061
Summers, Samantha M. Paper 153
Sun, Qin Paper 005
Sun, Yan Poster EDU-065
Sun, Yinghua Paper 151
Sussman, Betsy Poster EDU-051
Sussman, Marshall Paper 142
Poster SCI-051
Suzuki, Yasuyuki Poster SCI-012
Swami, Vimarsha G. Poster EDU-061
Swana, Hubert Poster SCI-023
Syzonenko, Veronika Paper 069
Sze, Raymond Paper 003 (T)
Paper 004 (T)
Paper 014 (T)
Paper 017
Paper 024
Paper 030
Paper 041
Paper 089
Paper 091
Paper 156
Paper 157
Poster SCI-025
Poster SCI-035
T
Tabak, Benjamin Poster CR-006
Tabari, Azadeh Paper 055
Paper 056
Tai, Chau Poster EDU-054
Talmadge, Jennifer Poster EDU-027
Tamir, Jon Paper 135
Tamir, Jonathan I. Poster EDU-003
Tang, Phua Hwee Paper 018
Tanifum, Eric Paper 110
Tanton, Phillip Poster CR-006
Taori, Abhijeet Poster CR-009
Poster EDU-010
Tareen, Naureen G. Paper 141
Tate, Alyssa Poster SCI-025
Taylor, George A. Paper 157
Teixeira, Sara R. Paper 134
Temkit, M'hamed Paper 074
Temple, Michael Paper 012
Poster SCI-033
Temple, William Paper 082
Termine, Carl A. Poster SCI-037
Territo, Paul R. Paper 095
Thakrar, Pooja Poster EDU-055
Theruvath, Ashok J. Paper 081
Paper 086
Thomas-Chausse, Frederic Paper 058
Poster EDU-005
Thompson, Allison Poster SCI-002
Thompson, Atalie C. Poster SCI-055
Thompson, Benjamin Paper 016
Paper 149
Paper 164
Thompson, Matthew O. Poster SCI-055
Thorpe, Kevin Poster EDU-061
Timsina, Lava R. Poster SCI-011
Tkach, Jean A. Paper 003
Paper 007
Tolend, Mirkamal Poster EDU-061
Tong, Jane Poster CR-007
Toslak, Iclal E. Poster SCI-054
Touma, Zahi Poster EDU-061
Towbin, Alexander J. Alt 003
Paper 060
Paper 084
Poster EDU-023
Poster EDU-028
Poster EDU-031
Trahan, Sean Paper 041
Poster SCI-035
Treanor, Lee Poster EDU-001 (T)
Trivedi, Premal Paper 118
Trout, Andrew T. Alt 003
Paper 003
Paper 005
Paper 006
Paper 007
Paper 084
Paper 150
Paper 153
Paper 154
Poster EDU-031
Tsai, Andy Paper 066
Tse, Shirley Paper 012
Poster EDU-061
Tshuma, Makabongwe Paper 078
Tsuda, Takeshi Poster SCI-008
Tsui, Edison Poster EDU-004
Tsutsumi, Yoshiyuki Poster SCI-012
Turner, Sara E. Poster EDU-017 (T)
Turney, Don R. Paper 046
Tydings, Caitlin Paper 138
Tzaribachev, Nikolay Poster EDU-061
U
Udayasankar, Unni K. Poster EDU-035
Ugas Charcape, Carlos Paper 133
Ulikowska, Ewelina Poster EDU-012 (T)
Urbine, Jacqueline Poster EDU-032
Utama, Evelyn Gabriela Paper 018
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S232
V
Vali, Reza Poster SCI-065
van der Heijde, Desiree Poster EDU-061
van Rossum, Marion A. Poster EDU-061
VanSyckel, Arielle Poster EDU-016
Vasanawala, Shreyas Paper 103
Paper 121
Paper 122
Paper 123
Paper 124
Paper 135
Paper 136
Poster SCI-059
Vatsky, Seth Paper 041
Poster EDU-047
Vellody, Ranjith Paper 008
Poster SCI-039
Victoria, Teresa Paper 092
Paper 109
Poster EDU-042
Villani, Anita Paper 087
Vo, Kieuhoa Paper 082
Vorona, Gregory Poster EDU-041
Voss, Stephan Paper 051
Paper 080
Vu, John Poster SCI-057
W
Wallace, Andrew B. Paper 002
Paper 099
Poster EDU-001
Wallihan, Rebecca Poster SCI-069
Walters, Michele Paper 066
Wang, Dah-Jyuu Poster EDU-057
Wanner, Matthew R. Paper 112
Poster EDU-020
Warfield, Simon K. Paper 026
Wasserman, Jonathan Poster SCI-067
Watal, Pankaj Poster EDU-069
Weber, Jonathon Poster SCI-040
Weiss, Pamela F. Poster EDU-061
Weiss, Ruth Paper 137
Wellings, Elizabeth P. Poster EDU-050
Wells, Greg Paper 137
Wermers, Joshua D. Poster EDU-093
Wheeler, Charles Poster SCI-019
Whitaker, Jayme Poster EDU-046
Poster EDU-047
White, Ammie M. Paper 015 (T)
Paper 017
Paper 032
Paper 035
Paper 036
Paper 092
Paper 097
Paper 116
Whitehead, Matthew Poster EDU-009
Poster EDU-070
Whiting, Bruce Paper 072
Whitmore, Morgan Paper 010
Whitson, Dawn Paper 002 (T)
Widjaja, Elysa Paper 130
Wieck, Minna M. Poster EDU-024
Wiggins, Roy Poster SCI-027
Willemink, Martin Paper 151
Paper 165
Wilson, Justine Paper 008 (T)
Wilson, Nagwa Poster EDU-064
Winer, Amy C. Poster EDU-092
Wise, Rachel Poster SCI-011
Wishah, Fidaa Paper 023
Paper 135
Wood, Joanne Paper 017
Wright, Jason Paper 132
Wu, Jennifer Poster EDU-004
Poster EDU-034
Wusik Healy, Katherine Paper 101
X
Xanthakos, Stavra A. Paper 007
Xiang, Henry Paper 113
Xie, Sophia Poster CR-012
Xu, Lin Paper 143
Y
Yadav, Bhupender Paper 008
Poster SCI-039
Yamada, Takahiro Poster SCI-014
Yarmolenko, Pavel Paper 138
Yazdani, Milad Poster SCI-015
Yecies, Derek W. Paper 126
Yen, Christopher J. Paper 048
Poster CR-010
Yeom, Kristen W. Paper 107
Paper 126
Yim, Deane Paper 039
Yin, Chen Poster EDU-074
Yoo, Shi-Joon Paper 039
Yoo, Won Joon Poster SCI-045
Youssfi, Mostafa Poster SCI-017
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S233
Yu, Qinlin Paper 089
Paper 091
Yuan, Jianmin Paper 136
Z
Zafer, Rizwan Paper 049
Zakko, Jason Paper 115
Zapala, Matthew A. Paper 065
Paper 082
Zaritzky, Mario F. Poster EDU-024
Zarka, Anthony I. Paper 111
Zbinden, Jacob Paper 115
Zei, Markus Poster SCI-057
Zember, jonathan Paper 138
Zeng, David Y. Paper 103
Paper 123
Zhang, Bin Paper 084
Zhang, Wei Paper 038
Paper 048
Paper 079
Paper 120
Paper 129
Zhang, Yue Poster SCI-005
Zheng, Qiang Paper 089
Paper 091
Zhong, Yumin Paper 143
Poster SCI-007
Poster SCI-018
Zhou, Kun Paper 054
Zhou, Ying Poster SCI-018
Zhu, Xiaowei Poster EDU-046
Zhuang, Hongming Poster SCI-062
Zuccaro, Jennifer Poster SCI-041
Zuccoli, Giulio Paper 134
Zucker, Evan J. Paper 037
Zumberge, Nicholas A. Paper 016
Paper 020
Paper 164
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S234
2019 KEYWORD INDEX BY ABSTRACT
3D
3D Paper 065
3D Imaging Poster EDU-002 (T)
3D Modeling Paper 030
3D Printing Paper 003 (T)
Paper 004 (T)
Paper 013 (T)
Paper 014 (T)
Paper 030
Paper 041
Poster EDU-043
Poster EDU-044
Poster SCI-022
Poster SCI-035
Poster SCI-047
Poster SCI-058
A
Abdomen Poster CR-004
Poster EDU-032
Abdominal trauma Poster CR-007
ABPA Poster SCI-066
Abscess Paper 073
Abusive Head Trauma Paper 125
Acetabular Fractures Poster EDU-055
Acquired lesions Poster EDU-064
Acute scrotal pain Poster CR-003 (T)
Adnexal torsion Paper 022
Poster EDU-035
Airway Paper 100
Poster EDU-016 (T)
ALARA Paper 071
Poster EDU-001 (T)
Poster SCI-002
Poster SCI-003
Poster SCI-004
Ambiguous genitalia Poster EDU-011
Anesthesia Paper 118
Poster SCI-002 (T)
Aneurysm Poster EDU-001
Aneurysmal Bone Cyst Paper 009
Poster SCI-036
Poster SCI-040
Angiography Paper 103
Poster EDU-005
Annular fissure Paper 052
Anomaly Poster EDU-014
Anorexia Poster EDU-033
Anterior meningocele Poster EDU-012
Aorta Poster EDU-001
Appendicitis Paper 072
Paper 073
Paper 155
Poster EDU-022
Appropriateness Poster SCI-006
Appropriateness Criteria Poster EDU-001 (T)
Aqueductal Stenosis Poster EDU-063
ARPKD Poster EDU-007
Arterial Spin Labeling Paper 089
Paper 091
Poster EDU-071
Arthritis Paper 012
Artifact Paper 002
Artificial intelligence Paper 060
Poster EDU-010 (T)
ASL Paper 090
Paper 125
Atypical malrotation Poster EDU-020
Autoimmune hepatitis Paper 154
AVID Poster EDU-063
B
Back Poster SCI-037
Balloon occlusion Paper 014
BCG vaccine: adverse reaction Poster SCI-045
Benign Poster EDU-082
Bicycle Poster EDU-027
Biliary Poster EDU-021
Biliary Atresia Paper 151
Biopsy Paper 013
Bismuth breast shields Poster SCI-005
Blade / Propeller\R Paper 054
Blood flow Paper 039
Blood Saturation Paper 122
BOLD MRI Paper 137
Bone age Paper 059
Paper 060
Bone Biopsy Paper 008
Bone Density Poster EDU-017 (T)
Bone Dysplasia Poster EDU-058
Bone health Poster EDU-017 (T)
Poster SCI-046
Bone marrow Poster EDU-057
Poster SCI-049
Bone tumor Poster EDU-088
Bonexpert Paper 059
Bowel Poster EDU-003 (T)
Bowel Phantom Poster SCI-022
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S235
Bowel Ultrasound Poster SCI-022
Brachial plexus birth injury (BPBI) Poster EDU-015 (T)
Brain Paper 055
Paper 088
Paper 093
Paper 095
Paper 107
Paper 134
Poster EDU-010
Brain model Poster SCI-058
Brain MRI Paper 056
Brain network Paper 129
Brain tumor Paper 131
Paper 132
Branchial anomaly Paper 078
Breast Poster EDU-093
Bridging vein rupture Paper 057
Bronchial tree Poster EDU-044
Bronchopulmonary malformation Poster EDU-091
Burnout Paper 157
Button battery Paper 105
Poster SCI-031
C
CAD Paper 063
Cancer Paper 08
Poster EDU-088
Capitular-radial distance Poster SCI-044
Cardiac Paper 033
Paper 120
Poster EDU-002
Poster EDU-002 (T)
Poster EDU-004
Cardiac Iron Paper 123
Cardiomyopathy Poster SCI-009
Poster SCI-010
Cardiorenal Paper 121
Cardiovascular Disease Paper 031
Catheter Paper 048
Caudal duplication Poster CR-003
CCHS Poster EDU-086
Central nervous system Poster EDU-065
Central venous catheter Paper 047
Cerebellar mutism Paper 126
Cerebral Blood Flow Poster SCI-015
Cervical lymphadenopathy Poster SCI-067
ceVUS Poster EDU-038
ceVUS phantom Paper 024
CHAOS Poster SCI-012
CHD related Syndromes Poster EDU-006
Chest Paper 015 (T)
Child Abuse Paper 017
Paper 113
Child maltreatment Paper 111
Childhood interstitial lung disease Poster EDU-090
Children Paper 163
Poster EDU-018
Poster EDU-025
Poster EDU-064
Poster SCI-053
Chylous scites Paper 008 (T)
Ciliopathy Poster EDU-058
Classic metaphyseal lesion Paper 112
clinical effectiveness Paper 150
common cause analysis Paper 159
Complications Paper 048
Computed tomographic angiography Paper 033
Computed tomography Paper 083
Poster EDU-091
Computer-aided diagnosis Paper 062
Conductive hearing loss Poster EDU-080
Congenital Poster EDU-002
Poster EDU-050
Poster EDU-072
Congenital fibular deficiency Poster EDU-060
Congenital Heart Disease Paper 122
Congenital infection Paper 128
Conjoined twins Poster CR-010
Connectome Paper 130
Consultant Paper 015
Contrast Paper 034
Paper 084
Paper 093
Paper 110
Paper 141
Poster CR-002 (T)
Poster EDU-038
Contrast enhanced ultrasound Paper 001
Paper 098
Contrast enhanced voiding
urosonography
Paper 023
Paper 024
Contrast MRI Paper 139
Contrast to Noise Poster SCI-057
Contrast Ultrasound Paper 139
Convolutional Neural Networks Paper 061
Paper 062
Paper 063
Coronary Paper 034
Poster SCI-008
Corpus callous morphology Poster SCI-053
Cortical malformations Poster EDU-017
Cost Paper 135
Poster SCI-030
Cost-effectiveness Paper 163
CPAM Poster SCI-013
Cranial Poster EDU-068
CRD Poster SCI-044
Cryoablation Poster SCI-040
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S236
CT Paper 035
Paper 036
Paper 072
Paper 082
Poster EDU-002
CT angiogram Paper 101
Poster CR-010
CT dose Poster SCI-005
CT-occult tumor Poster SCI-039
CTA Paper 034
Paper 037
Poster SCI-008
Custom Software Paper 049
Customer Paper 006 (T)
Cyst Paper 028
Cystic nephroma Poster EDU-087
D
DDH Paper 067
Deep Brain Stimulation Paper 130
Deep learning Paper 094
Paper 103
Paper 107
Poster SCI-059
Dermoid Poster EDU-070
Developmental Dysplasia of the Hip Paper 068
Developmental maturity Poster SCI-044
Dexa Poster EDU-007 (T)
Diagnostic accuracy Paper 087
Diaphragm pacer Poster EDU-086
DICER1 Poster EDU-087
Difficult venous access Poster SCI-033
Diffusion MRI Paper 054
Digital PET/CT Paper 079
Disease Paper 146
Disease severity Poster SCI-069
Distortion and susceptibility Paper 054
Distraction method Poster SCI-065
DMD Poster SCI-046
Doppler Paper 088
Poster EDU-068
Dose neutrality Paper 074
Dose Reduction Paper 075
Poster SCI-001 (T)
DSD Poster EDU-011
Dual energy Paper 037
Paper 075
Paper 099
Duchenne Poster SCI-046
Dwarfism Poster EDU-051
DWI Paper 004
Paper 136
Paper 143
Poster SCI-060
DXA Poster EDU-017 (T)
Dynamic Airways Poster SCI-001
Dynamic contrast-enhanced Poster SCI-032
Poster SCI-043
Dynamic contrast enhanced MRI Paper 025
Dysostosis Poster EDU-051
Dystonia Paper 130
E
Ear Paper 108
Eating disorder Poster EDU-018
Education Paper 018
Paper 160
Poster SCI-006
Poster SCI-025
Poster SCI-031
Poster SCI-062
EEG Poster SCI-052
Effective Dose Poster SCI-001
Elastography Paper 149
Paper 151
Elbow Paper 064
Paper 065
Paper 144
Emergency Paper 033
Poster EDU-022
Poster EDU-036
Poster SCI-024
Poster SCI-031
Endocarditis Paper 080
Endovascular phantom Paper 041
Enema Paper 077
Engagement Paper 006 (T)
Enteric cyst Poster EDU-012
Enthesitis related arthritis Paper 143
Eovist Paper 002
Epidermolysis bullosa Poster EDU-023
Epididymitis Poster CR-003 (T)
Epilepsy Paper 129
Poster EDU-072
Everolimus Paper 131
Ewing Sarcoma Paper 086
Exercise Paper 137
Extramedullary Hematopoiesis Poster CR-009
Extremity Poster EDU-014
Eye Poster EDU-009
F
Falciform ligament Poster CR-006
Fast Imaging Paper 055
Paper 056
Fat fraction Poster SCI-049
Fatty appendage torsion Poster CR-006
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S237
FCD Poster EDU-069
FDG PET/CT Paper 080
Ferromagnetic detection Poster EDU-005 (T)
Ferumoxytol Paper 053
Paper 081
Paper 086
Fetal Paper 107
Paper 108
Paper 109
Poster EDU-009
Poster EDU-014
Poster EDU-015
Fetal CT Poster SCI-014
Fetal imaging Poster EDU-016
Poster EDU-079
Fetal MRI Poster SCI-011
Fetal sonography Paper 106
Fetal ultrasonography Poster EDU-013
Fetus Poster SCI-012
Fibrocartilaginous disc emboli Paper 052
Fibrosis Paper 148
Flat panel dectors Paper 070
Flow Paper 121
Fluoroscopy Paper 001 (T)
Paper 070
Poster EDU-026
Poster EDU-043
Focal cortical dysplasia Poster EDU-069
Poster SCI-057
Fontan Paper 039
Foot Deformities Poster EDU-050
Fracture Paper 064
Poster EDU-062
Poster SCI-026
Fracture detection Paper 061
Fracture Healing Paper 113
Free breathing cine Paper 118
FTE Paper 011 (T)
G
Gadolinium retention Paper 131
Paper 132
Gastrobronchial Fistula Poster CR-011
Gastrointestinal Poster EDU-028
Poster EDU-032
Gastrointestinal disorder Poster EDU-003 (T)
Gastrostomy Paper 014
Gaucher disease Poster EDU-057
Gender Paper 158
General Anesthesia Paper 018
Genetics Paper 032
Poster EDU-051
Germinal matrix hemorrhage Paper 094
GFR Paper 026
Glenohumeral Poster EDU-015 (T)
Glomerular filtration rate Paper 025
GRASP Poster SCI-050
Grayscale Poster SCI-054
GU Poster EDU-037
H
Head ultrasound Paper 050
Poster SCI-055
Healing phases Paper 112
Healthcare Policy Poster SCI-029
Hemangioma Paper 058
Poster EDU-093
Hematocrit Poster SCI-055
Hemimelia Poster EDU-060
Hemophilia Paper 142
Poster SCI-051
Hemorrhage Paper 096
Hepatic involvement Poster EDU-057
Hepatoblastoma Poster EDU-085
Poster SCI-018
Hip Paper 014 (T)
Hip Dysplasia Paper 139
Hip variant Poster EDU-055
Histiocytosis Poster CR-004
Holoprosencephaly Poster EDU-063
Human parechovirus Paper 127
HYDATID Poster SCI-068
Hydrocephalus Paper 095
Hypertrabeculation Paper 117
Hypoxic Ischemic Encephalopathy
(HIE)
Poster SCI-015
Hypoxic ischemic injury Paper 089
Paper 091
Paper 092
Poster EDU-008
I
Iliac Vein Compression Paper 045
Image Poster EDU-065
Image fusion Poster SCI-039
Image Gently Poster EDU-001 (T)
Image-guided Paper 011
Image intensifiers Paper 070
Image quality Paper 056
Paper 069
Image reconstruction Paper 124
Imaging Paper 005 (T)
Paper 071
Poster EDU-028
Poster EDU-033
Poster SCI-048
Imaging Transcranial Doppler Poster EDU-074
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S238
Imaging trials Poster EDU-042
Immunotherapy Paper 083
Implementation Paper 060
In house Lab Paper 003 (T)
In-phase Poster EDU-059
Infant Poster CR-005
Poster EDU-062
Poster EDU-090
Poster SCI-045
Infantile myofibromatosis Poster CR-002
Infection Paper 141
Poster EDU-095
Inflammatory bowel disease Poster EDU-003 (T)
Inflammatory Myofibroblastic Tumor Poster CR-014
Poster CR-005
Informatics Paper 015
Poster SCI-025
Ingestible Paper 009 (T)
Innovation Paper 005 (T)
Interdepartmental Wellbeing Paper 156
Interventional Paper 014
Paper 048
Poster SCI-038
Interventional fluoroscopic Poster EDU-046
Interventional MRI Poster EDU-047
Interventional Radiology Poster CR-010
Poster SCI-037
Intracranial hemorrhage Poster SCI-055
Intrathecal administration Poster EDU-048
Intussusception Paper 076
Paper 077
Poster SCI-020
Poster SCI-021
Iron Paper 123
Paper 147
Iron Overload Paper 123
Islet cell transplantation Poster EDU-024
Isolette Poster SCI-001 (T)
IVIM Paper 027
IVUS (Intra-vascular Ultrasound) Paper 115
Paper 016 (T)
J
Joint Commission Accreditation Paper 007 (T)
Joint Injection Paper 008
Joints Paper 142
Juvenile Arthritis Poster EDU-013 (T)
Juvenile dermatomyositis Paper 137
Juvenile idiopathic arthritis Poster EDU-061
K
Ketogenic diet Paper 080
Kidney Paper 026
Klippel-Trenaunay syndrome Poster SCI-023
Knee Paper 135
L
Langerhans Cell Histiocytosis Poster EDU-012 (T)
Poster SCI-063
Leadership Paper 158
Learning Paper 162
Leptomeningeal Poster CR-012
Leukemia Poster EDU-065
Poster SCI-049
LGE Poster SCI-010
Li-Fraumeni Paper 087
Liver Paper 004
Paper 145
Paper 146
Paper 147
Paper 148
Paper 149
Paper 150
Paper 152
Paper 153
Poster EDU-021
Poster SCI-018
Liver lymphatics Paper 116
Liver transplant Paper 001
Paper 046
LMS Paper 161
Paper 162
Long-bone fractures Paper 063
Long Bone Growth Paper 066
Low b-value images Paper 004
Low-dose Paper 069
Low flow vascular malformation Poster EDU-012
Ludwig's angina Poster CR-001
Lugano Poster EDU-089
Lung Paper 015 (T)
Poster EDU-007
Poster EDU-090
Lung ultrasound Paper 097
Lymphangiography Paper 098
Paper 008 (T)
Poster SCI-032
Lymphatic malformation Paper 040
Poster EDU-096
Poster SCI-023
Lymphoma Poster EDU-089
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S239
M
Machine based correlative
enhancement
Poster SCI-057
Machine Learning Paper 059
Paper 124
MAGEC Poster EDU-092
MAGEC Rod Poster EDU-014 (T)
Magnetic Resonance Paper 058
Poster EDU-003
Poster EDU-005
Magnetic resonance
cholangiopancreatography
Paper 154
Magnetic resonance imaging Paper 110
Paper 136
Poster EDU-040
Poster SCI-053
Poster SCI-059
Magnetic Resonance Spectroscopy
(MRS)
Poster SCI-015
Magnetic resonance venography Paper 057
Malrotation Paper 001 (T)
Poster EDU-020
Poster SCI-017
Marrow Poster EDU-059
Masses Poster EDU-075
May-Thurner Syndrome Paper 045
MCDK Poster EDU-007
MDCT Poster SCI-068
Mdixon Paper 003
MDTH Poster SCI-069
Medical Imaging Poster EDU-010 (T)
Medulloblastoma Paper 126
Melanocytosis Poster CR-012
Mesentery Poster CR-005
Metabolic Paper 134
Metastases Poster CR-009
Methods Paper 164
MIBG Poster EDU-081
Poster SCI-064
Microcephaly Paper 128
Midface anomaly Poster EDU-016
Migrational anomalies Poster EDU-017
Mimic Poster EDU-019
Mobius Poster EDU-076
Modified look-locker Paper 007
Mold Making Paper 004 (T)
MOLLI Paper 007
MR Paper 028
Paper 109
Paper 144
MR-guided procedures Poster EDU-047
MR lymphangiograpy Paper 116
MR safety Paper 009 (T)
MRA Paper 053
Paper 119
MRI Paper 002
Paper 006
Paper 018
Paper 026
Paper 055
Paper 073
Paper 095
Paper 115
Paper 119
Paper 134
Paper 138
Paper 148
Poster CR-001 (T)
Poster EDU-015
Poster EDU-021
Poster EDU-022
Poster EDU-041
Poster EDU-079
Poster SCI-002 (T)
Poster SCI-012
Poster SCI-013
Poster SCI-032
Poster SCI-048
Poster SCI-050
Poster SCI-066
Poster SCI-068
MRI analytics Poster SCI-027
MRI brain Poster SCI-058
MRI criteria Paper 155
MRI log Poster SCI-027
MRI Safety Paper 010 (T)
Poster EDU-005 (T)
MRI Safety employee Paper 011 (T)
MRI scan Poster SCI-027
MRI Sedation Poster SCI-030
MRI/MRA Paper 105
MRIs Paper 020
Mullerian Duct Anomalies Poster EDU-034
Multi-energy CT Paper 074
Multi-Institutional Poster EDU-042
Multi-system Poster EDU-095
Multimodality guidance Poster SCI-039
Musculoskeletal Paper 010
Paper 011
Paper 012
Paper 141
Poster EDU-013 (T)
Poster EDU-054
Poster SCI-043
Myelomeningocele Paper 096
N
Neck Paper 051
Poster EDU-070
Poster EDU-075
Necrotizing Enterocolitis Poster EDU-004 (T)
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S240
Neonatal Paper 090
Paper 108
Paper 127
Poster EDU-010
Poster EDU-068
Neonate Paper 088
Paper 089
Paper 091
Neoplastic Poster CR-014
Nephroblastoma Paper 029
Nephrogenic rest Paper 029
Nerve block Paper 008
Nervosa Poster EDU-033
Neural network Poster SCI-059
Neuroblastoma Paper 082
Paper 083
Paper 084
Poster CR-009
Poster EDU-081
Poster EDU-085
Poster EDU-086
Poster SCI-064
Neurocritical Care Unit Poster EDU-074
Neuroradiology Paper 127
Paper 133
Poster EDU-079
Neurosonogram Paper 094
Neutropenic Fever Poster SCI-056
Newborn Poster EDU-004 (T)
Non Accidental Trauma Paper 002 (T)
Paper 112
Non-contrast Poster EDU-002 (T)
Noncontrast MRA Paper 120
Nonrotation Poster EDU-020
Nusinersen Poster EDU-048
Nutrition Poster EDU-018
O
Obesity Paper 031
Obstruction Paper 076
OCD Paper 144
Off-resonance Paper 103
OHVIRA Poster EDU-034
Olfactory Bulb Poster EDU-073
Olfactory sulcus Poster EDU-073
Olfactory system Poster EDU-073
Oligohydramnios Paper 106
OMERACT Poster EDU-061
Omphalocele Poster SCI-011
Omphalomesenteric duct Poster EDU-029
Oncology Paper 085
Paper 138
Poster SCI-060
Opposed-phase Poster EDU-059
Optimization Paper 160
Poster EDU-008 (T)
Optimization Protocol Poster SCI-051
Orbital Poster EDU-009
Ossified soft tissue Poster EDU-052
Osteoid Osteoma Paper 010
Osteomyelitis Paper 011
Poster SCI-045
Poster SCI-050
Osteosarcomas Paper 086
Outcomes measures Paper 068
Poster EDU-061
Ovarian torsion Paper 022
Ovaries Paper 022
Oxygenation Paper 122
P
Paediatric Poster SCI-065
Pain management Poster SCI-065
Pancreas Paper 005
Paper 006
Paper 153
Poster EDU-031
Pancreatitis Paper 005
Paper 006
Poster SCI-019
Parallel imaging Poster EDU-041
Parametric Mapping Poster SCI-009
Patent ductus arteriosus Paper 038
Patient Care Paper 005 (T)
Patient Education Paper 013 (T)
Patient Histories Paper 016
Patient-Specific Poster SCI-047
PDA stent Paper 038
Peak Skin Dose Estimation Poster EDU-046
Pediatric Paper 010
Paper 013
Paper 038
Paper 079
Paper 044
Paper 120
Paper 145
Paper 146
Poster CR-002 (T)
Poster CR-014
Poster EDU-007 (T)
Poster EDU-028
Poster EDU-067
Poster EDU-074
Poster EDU-094
Poster SCI-008
Pediatric Hip Poster EDU-055
Pediatric Imaging Poster EDU-080
Pediatric oncologic emergency Poster EDU-084
Pediatric scrotal Ultrasound Poster CR-003 (T)
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S241
Pediatric trauma Paper 104
Paper 165
Peer learning Paper 159
Peer review Poster SCI-028
Pelvic Poster EDU-036
Percutaneous therapy Poster SCI-036
Perfusion Paper 090
Peripheral Nervous System Poster EDU-053
Peripherally inserted central catheter Paper 047
Peritoneum Poster CR-008
PET Poster EDU-089
PET/CT Paper 079
Poster SCI-063
PET/MR Paper 081
Poster EDU-008 (T)
Poster EDU-082
Poster EDU-088
PET/MRI Poster EDU-066
Poster EDU-082
Poster SCI-060
PHACE Paper 058
Phantom Paper 004 (T)
Poster EDU-044
Poster SCI-035
Phase contrast MRI Paper 039
Paper 121
Physician wellness Paper 157
Physics Poster EDU-066
Poster EDU-071
Physis Poster SCI-048
PICC Poster EDU-049
Pierre-Robin Poster EDU-076
Piriform sinus fistula Paper 078
Pitfall Poster EDU-019
Pituitary abnormalities Poster EDU-077
Placenta Paper 110
PLE Paper 008 (T)
Pleural Poster EDU-094
Pleuropulmonary blastoma Poster EDU-087
POCUS Paper 021
Point-of-care Paper 161
Poland Poster EDU-076
Portal hypertension Paper 046
Portal vein Paper 046
Power Injector Paper 035
Prenatal Poster EDU-011
Poster SCI-013
PRETEXT staging system Poster SCI-018
Primary sclerosing cholangitis Paper 154
Progeria Paper 066
Prognostication Poster SCI-011
Projectile hazards Poster EDU-005 (T)
Protocol Paper 019
Poster EDU-026
Poster SCI-002
Proton density fat fraction Paper 003
PTLD Poster EDU-083
Puberty Poster EDU-077
Pulmonary Poster EDU-004
Pulmonary arteriovenous malformation Paper 101
Pulmonary artery Paper 037
Pulmonary embolism Paper 044
Paper 102
Pulmonary hypoplasia Paper 106
Pulmonary regurgitation Poster SCI-007
Pulmonary vein Paper 036
Pyloric Poster EDU-025
Q
QI Paper 016
Quality Paper 015
Paper 164
Poster SCI-024
Quality-adjusted life years Paper 163
Quality Improvement Paper 017
Paper 051
Poster SCI-026
Poster SCI-029
Poster SCI-030
Quantitative Paper 152
R
r2* Paper 003
Radial imaging Poster EDU-041
Radial MRI Poster SCI-043
Radiation Poster SCI-004
Radiation Data Management System Poster EDU-046
Radiation Dose Paper 099
Poster SCI-014
Radiogenomics Poster SCI-069
Radiographic findings Poster EDU-012 (T)
Radiography Poster SCI-003
Poster SCI-026
Radiology Poster SCI-024
Radiology Personnel Paper 164
Rapid MRI Poster EDU-035
RASA1 Poster EDU-005
Reactive appendicitis Poster CR-007
Recurrence Paper 077
Recurrent neural network Paper 102
Reduced morbidity Poster SCI-033
Registry Poster EDU-042
Regulatory Readiness Paper 007 (T)
Reimbursement Poster SCI-029
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S242
Renal Paper 028
Renal artery stenosis Paper 042
Paper 043
Renovascular hypertension Paper 042
Paper 043
Representation Paper 158
Resting state fMRI Paper 129
Risk Paper 159
RUFIS Paper 136
S
Sacroiliac joint Paper 143
Sacroiliitis Poster SCI-042
Safety Paper 035
Paper 118
SAR Paper 109
Scars Poster SCI-041
Scleroderma Poster SCI-041
Sclerotherapy Paper 009
Scoliosis Paper 012 (T)
Paper 069
Poster EDU-009 (T)
Poster EDU-092
Scoreless Poster SCI-028
Sedated Paper 020
Segmentation Paper 030
Seizure Poster CR-012
Poster EDU-072
Poster SCI-052
Septic Emboli Poster CR-001
Shear wave Paper 153
Shear wave elastography Paper 050
Sickle Cell Poster EDU-018 (T)
SID Poster SCI-001 (T)
Simulation Paper 072
Poster EDU-040
Poster EDU-043
Poster SCI-035
Single puncture technique Paper 047
Sinus Mucosal Thickening Poster SCI-056
Sirolimus Paper 040
SIRT Poster EDU-019 (T)
SIS Fistula Plug Poster CR-011
Size Paper 005
Size-specific dose estimate Paper 075
Skeletal dysplasia Poster SCI-014
Skeletal manifestations Poster EDU-012 (T)
Skeletal Maturation Paper 066
Skeletal Survey Paper 017
Paper 111
Poster SCI-063
Skin Dose Poster SCI-001
Skull base lesion Poster EDU-067
SMA CUT-OFF Poster SCI-017
SMA Syndrome Poster CR-001 (T)
Soft tissue mass Poster EDU-056
Soft tissue of neck Poster EDU-016 (T)
Sonoelastography Poster SCI-041
SPECT/CT Poster EDU-081
Poster SCI-064
Spectral CT Paper 074
Spinal cord infarct Paper 052
Spinal muscular atrophy Poster EDU-048
Spinal rods Paper 012 (T)
Spine fractures Paper 104
Spleen Poster EDU-030
Poster EDU-032
Split-bolus Single-pass protocol Paper 165
SSDE Poster SCI-004
Staff Paper 006 (T)
Standardization Paper 019
Poster EDU-091
Standardized Uptake Values Paper 081
Steatosis Paper 145
Stenosis Paper 036
Stiffness heterogeneity Paper 149
Strain Poster SCI-007
Stroke Poster EDU-006
Structured reports Paper 085
Subdural hematoma Paper 057
Subspecialization Paper 161
Surgical Guides Poster SCI-047
Superficial Poster EDU-056
Supparative thyroiditis Paper 078
Suprasternal Poster EDU-070
Surveillance Paper 132
Survey Poster SCI-028
Suspected Abuse Paper 002 (T)
SWI Poster SCI-052
Synovial biopsy Paper 012
T
T1 mapping Paper 007
T2 Map MRI Paper 142
Poster SCI-051
T2 Shuffle Paper 135
T2* Paper 147
TARE Poster EDU-019 (T)
TCD Poster EDU-018 (T)
Teaching File Paper 160
Technologist Paper 019
Poster EDU-010 (T)
Technology Paper 071
Technology dependence Poster SCI-033
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S243
Temporal Bone Poster EDU-064
Poster EDU-080
Tenosynovitis Poster EDU-011 (T)
Tetralogy of fallot Poster SCI-007
Thoracic Paper 099
Poster EDU-001
Poster SCI-003
Poster SCI-066
Thoracic duct patency Paper 098
Thoracic spine Paper 104
Three-vessel tracheal view Poster EDU-013
Thrombolysis Paper 044
Thrombophlebitis Poster CR-001
Thrombosis Paper 001
Thymic rest Poster CR-013
Thyroid Paper 013
Poster CR-013
Thyroid carcinoma Poster SCI-067
Thyroiditis Poster SCI-054
Time Since Injury Paper 113
TiRAD Poster CR-013
Tissue Engineering Paper 115
Tomosynthesis Paper 065
Torsion Poster CR-006
Poster EDU-036
Total pancreatectomy and islet
autotransplant
Poster EDU-024
TPIAT Poster EDU-024
Tracheomalacia Paper 100
Tracking Paper 162
Trans thoracic contrast enhanced
echocardiography
Paper 101
Transcranial Doppler Paper 049
Poster EDU-018 (T)
Trauma Paper 051
Paper 064
Poster EDU-062
Poster SCI-002
Trigger Finger Poster EDU-011 (T)
Trigger Thumb Poster EDU-011 (T)
Tubal Torsion Poster EDU-035
Tuberculosis Poster EDU-095
Tumor Poster EDU-094
U
Ultrasonography Poster EDU-025
Ultrasound Paper 012 (T)
Paper 013 (T)
Paper 014 (T)
Paper 031
Paper 050
Paper 067
Paper 138
Paper 151
Poster CR-001 (T)
Poster CR-007
Poster EDU-004 (T)
Poster EDU-010
Poster EDU-013 (T)
Poster EDU-014 (T)
Poster EDU-019
Poster EDU-038
Poster EDU-053
Poster EDU-056
Poster EDU-075
Poster EDU-092
Poster EDU-093
Poster SCI-019
Poster SCI-020
Poster SCI-021
Poster SCI-054
Poster SCI-067
Ultrasound shear wave elastography Paper 150
Umbilical disorders Poster EDU-029
Upper GI Paper 001 (T)
Urachus Poster EDU-029
Utilization Poster SCI-006
V
Vaginal Reflux Poster CR-008
Varicose vein Poster SCI-034
Vascular Paper 053
Paper 100
Paper 119
Vascular Access Poster EDU-049
Vascular disease Paper 032
Vascular malformation Paper 040
Poster EDU-096
Vascular ring Poster EDU-013
Vasculature Poster CR-002 (T)
VCUG Paper 023
Poster CR-008
Poster EDU-037
Venography Paper 045
Venoocclusive disease Paper 152
Venous access Poster SCI-037
Venous Compression Syndromes Paper 016 (T)
Venous malformation Poster SCI-023
Virtual reality Poster EDU-040
Volvulus Poster SCI-017
VUR Paper 023
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245S244
W
Waveform Enveloping Paper 049
Wilms Poster EDU-085
Wilms tumor Paper 029
X
Xray Paper 016
Y
Yttrium Poster EDU-019 (T)
Pediatr Radiol (2019) 49 (Suppl 1):S1–S245 S245